Metatarsal Stress Fracture

ExitCare ImageA stress fracture is a break in a bone of the body that is caused by repeated stress (trauma) that slowly weakens the bone until it eventually breaks. The metatarsal bones are in the middle of the feet, connecting the toes to the ankle. They are vulnerable to stress fractures. Metatarsal stress fractures are the second most common type of stress fracture in athletes. The metatarsal of the pointer toe (second metatarsal) is the most common metatarsal to suffer a stress fracture.

SYMPTOMS

  • Vague, spread out pain or ache. Sometimes, tenderness and swelling in the foot.

  • Uncommonly, bleeding and bruising in the foot.

  • Weakness and inability to bear weight on the injured foot.

  • Paleness and deformity (sometimes).

CAUSES

A stress fracture is caused by repeated trauma. This slowly weakens the bone, faster than it can heal itself, until the bone breaks. Stress fractures often follow a sudden change in training schedule. Stress fractures may be related to the loss of menstrual period in women.

RISK INCREASES WITH:

  • Previous stress fracture.

  • Sudden changes in training intensity, frequency, or duration (military recruits, distance runners).

  • Bony abnormalities (osteoporosis, tumors).

  • Metabolism disorders or hormone problems.

  • Nutrition deficiencies or eating disorders (anorexia or bulimia).

  • The loss of or irregular menstrual periods in women.

  • Poor strength and flexibility.

  • Running on hard surfaces. Poor leg and foot alignment. This includes flat feet.

  • Poor footwear with poor shock absorbers.

  • Poor running technique.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Muscle strength.

  • Endurance and flexibility.

  • Wear proper and correctly fitted footwear. Replace shoes after 300 to 500 miles of running.

  • Learn and use proper technique with training and activity.

  • Increase activity and training gradually.

  • Treat hormonal disorders. Birth control pills can be helpful for women with menstrual period irregularity.

  • Correct metabolism and nutrition disorders.

  • Wear cushioned arch supports for runners with flat feet.

PROGNOSIS

With proper treatment, stress fractures usually heal within 6 to 12 weeks.

RELATED COMPLICATIONS

  • Failure to heal (nonunion), especially with stress fractures of the outer foot (upper part of the fifth metatarsal).

  • Healing in a poor position (malunion).

  • Recurring stress fracture.

  • Progression to a complete or displaced fracture.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), and need for further surgery.

  • Repeated stress fracture, not necessarily at the same site. (Occurs in 1 of every 10 patients).

TREATMENT

Treatment first involves ice and medicine to reduce pain and inflammation. You must rest from any aggravating activity, to avoid making the fracture worse. For severe stress fractures, crutches may be advised, to take weight off the injured foot. Depending on your caregiver's instructions, you may be permitted to perform activities that do not cause pain. Any menstrual, hormonal, or nutritional problems must be addressed and treated. Return to activity must be performed gradually, to avoid reinjuring the foot. Physical therapy may be advised, to help strengthen the foot and regain full function. On rare occasions, surgery is needed. This may be offered if non-surgical treatment is ineffective after 3 to 6 months.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (NSAIDS) or other minor pain relievers are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

Symptoms get worse or do not improve in 2 weeks, despite treatment.

The following occur after immobilization or surgery:

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site, especially under the toenails. Numbness or loss of feeling below the fracture site.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)