Metatarsal Stress Fractures

Description:

Metatarsal stress fractures are partial or complete fractures in the long bones of the foot (Figure 1). The wear and injury to the bone exceeds its ability to remodel or repair the damage inflicted by intense exercise or excessive load. The most common metatarsal stress fracture occurs at the neck of the second metatarsal secondary to excessive pronation and metatarsal loading. In addition, if the second metatarsal is long relative to the first (Morton’s foot) it will be subjected to increased loads. This can also occur in the third metatarsal if it is long relative to the second.

Signs & Symptoms:

• Vague, diffuse pain or ache in the foot,
• Intense localized tenderness at the fracture site,
• Forefoot swelling, redness and occasional increased skin temperature,
• Weakness and inability to bear weight on the foot,
• Pain with non-weightbearing bending stress, and
• Pain not severe at start of activity but worsens as activity continues.

Causes:

• Insulting repetitive forces on the foot that exceed the bone’s ability to repair,
• Sudden changes in exercise intensity, equipment or performance,
• Osteoporosis, and
• Ballet dancing.

Preventative Measures:

• Wear proper footwear replacing running shoes every 500-800kms,
• Gradual increases in activity intensity and allow time to adapt to changes in equipment,
• Proper nutritional diet, and
• Treat any existing hormonal disorders.

Management:

• Ice and relative rest from the deleterious activity,
• Temporary shoe modification to increase shoe stiffness, i.e. spring plate,
• Custom foot orthoses,
• Menstrual, hormonal or nutritional issues need be addressed,
• Gradual return to activity, and
• Electrotherapy modalities to promote bone healing.