Metatarsal Stress Fracture

A metatarsal stress fracture is a crack or break in one of the five metatarsal bones found in the foot. Sometimes these fractures will cause pain in the ball of the foot. A suspected stress fracture warrants an evaluation by a foot fracture specialist, even if initial treatment has been started in the emergency room. Runners and triathletes should stop any activity until they make sure the bone isn’t broken.

Stress fractures are very small cracks in the bone. These tiny, hairline breaks are most often caused by repetitive stress. We see this most often in runners and triathletes. The main culprit is a rapid increase in mileage while training for long distance events. Stress fractures are also caused by osteoporosis, abnormal foot structure (such as high arches), or other foot deformities. Overstriding or running with a long stride can also lead to stress fractures. Wearing the right shoes for your foot type is critical. You must choose the right shoes for your foot type in order to prevent stress fractures. If you suspect a stress fracture, stop running and don’t ignore it. They can worsen if left untreated. You might also be at risk for a pattern of recurring future injury.

Without proper treatment, this may progress to a “through and through” (overt) fracture of the bone. The second and third metatarsals are the most commonly affected. Metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.

Symptoms

  • Sharp pain in the forefoot, aggravated by walking
  • Tenderness to pressure on the top surface of a metatarsal bone
  • Diffuse swelling of the skin over the forefoot

Causes

  • Decreased density of the bones (ie osteoporosis)
  • Unusual stress on a metatarsal due to faulty foot mechanics or another forefoot deformity (eg. bunion)
  • Abnormal foot structure or mechanics (ie flat feet)
  • Increased levels of activity, especially without proper preparation (ie runners suddenly increasing mileage and training intensity)
  • Obesity

What You Can Do

  • Seek professional help as soon as possible
  • Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone.
  • Avoid the activity that led to the fracture. Stop running, cycling, and hiking until you get checked out.
  • It is important to make sure that you don’t injure the area further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches of a wheelchair in order to allow it to heal. Try to choose a foot fracture expert who understands the activities you enjoy so you can stay active while you heal.

What We Can Do

  • Request a bone scan or x-rays to confirm the fracture. X-rays do not show stress fractures until at least 14 days after the event
  • Apply orthopaedic taping and padding to relieve stress from the metatarsals
  • Splint the foot
  • Immobilization, casting, or stiff shoe. A cast, stiff shoe or mightt be needed to protect and stabilize the fractured bone while it is healing
  • Surgery. Depending upon the extent of the injury, some metatarsal fractures will heal much better with surgery to re-align and stabilize the bone
  • Wear a shoe with a very stiff sole
  • Use physical therapy in the later stages of healing
  • If you have had previous stress fractures, a detailed analysis of your running style will be undertaken to pinpoint any biomechanical problems and provide appropriate functional foot orthoses to prevent reoccurrence
  • Provide Detailed in-shoe pressure analysis with the aim of decreasing high loads to the injured area

Other causes of forefoot pain

  • Morton’s neuroma (benign tumour of a nerve running between the metatarsals)
  • Metatarsalgia (painful and inflammation of the metatarsal bones and their soft tissue sheath)
  • Capsulitis (painful and inflammation of the joints between the metatarsal bones and toes)
  • Tendonitis (inflammation of the tendons which course along the top of the foot)
  • Dislocation of a joint between a metatarsal and a toe (metatarsal-phalangeal joint)
  • Severe plantar callus(callus on bottom of the foot) or bursitis(an inflamed fluid-filled sack often between a bone and an area of pressure)