A stress fracture is a break in a bone caused by repetitive stress. It may occur in any bone, but it is quite common in the metatarsal bones of the foot. There is often no recollection of injury.
The patient may simply develop a painful forefoot after some activity, such as walking, sports, or stooping down onto the ball of the foot. The second and third metatarsals are the most commonly affected. A metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.
The above diagram shows the location of the metatarsals
Symptoms of a Metatarsal Stress Fracture
Sharp pain in the forefoot, aggravated by walking and running.
Tenderness to pressure on the top surface of a metatarsal bone.
Diffuse swelling of the skin over the forefoot.
The pain from a metatarsal stress fracture is usually felt on the top of the foot, over the affected metatarsal bone. The pain can be dull or sharp, constant or intermittent.
Pain may persist at rest and may even be severe enough to prevent sleep. There may be tenderness and swelling over the stress fracture. Activities like running can make the pain from a metatarsal stress fracture worse.
Hopping or jumping can be particularly painful. If a metatarsal stress fracture progresses to a complete fracture there may be crepitus (a crunching noise) over the fracture site. At this point pain usually prevents weight bearing.
Decreased density of the bones (e.g. osteoporosis)
Unusual stress on a metatarsal due to mal position or another forefoot deformity (e.g. bunion)
Abnormal foot structure or mechanics (e.g. flatfoot, over pronation)
Increased in hill running or speed work
Seek professional help as soon as possible
Keep weight off the foot, a removable cast is ideal
Ice the top surface of the forefoot for about 20 minutes every hour. To reduce swelling, wrap the foot in a tensor bandage with moderate compression.
Wear a running shoe with a stiffer sole or sports insoles.
You may need x-rays or a bone scan to confirm a fracture.
A sports podiatrist may apply orthopedic taping and padding to relieve stress from the metatarsals.
Silicone padding can be used to enable pain free walking and running during the healing process.
Occasionally a plaster cast is necessary.
Nutritional and hormonal deficiencies or irregularities must also be addressed. If you are based in the UK we would recommend the Dr Foot Podiatry and Chiropody Clinic for all your foot needs