Metatarsal Stress Fracture

Extracts from an article written by Jeffrey A. Oster, DPM, C.Ped and last updated 5/20/02.

Bone is a phenomenal tissue that has the ability to change, grow and restructure itself based upon the loads we apply to it.  Bone gives our bodies support and structure, it protects our many vital organs and it acts as a reservoir for the important minerals we need every day. Let's say we start to work out at the gym.  We plan to get big muscles to impress our significant other.  What supports those muscles?  That's right, bone.  Our new fitness plan increases loads applied to bone causing it to grow to be able to accept those new loads.  The opposite holds true also, decrease your activity and your bone mass will decrease.  That's why it's so important for seniors to maintain regular physical activity.

Stress fractures are quite common to the foot.  We mentioned before that bone carries load.  A stress fracture simply implies that the load applied to the foot was greater than what the bone could tolerate, so it breaks. The most common stress fracture that occurs in the foot is in the metatarsal bones.  These fractures are also referred to as march fractures.  The name came about as the result of forcing young, sedentary army recruits to march 20 miles with a full backpack.  Their transition from civilian to soldier was too abrupt resulting in a load that was greater than what the metatarsal bone could tolerate.

X-rays are necessary but aren't always so helpful with metatarsal stress fractures.  In most cases, metatarsal stress fractures can only be seen on x-ray three to four weeks after they occur.  X-ray findings of metatarsal stress fractures are very subtle in nature.  We don't actually see the fracture, but we see the deposition of calcium surrounding the fracture as the bone heals.  This finding is referred to as bone callus and is the body's own internal cast, so to speak.

The technique of treating fractures varies on a fracture by fracture basis but the fundamental principles are the same. The first thing we have to do is to confirmed on X-ray that the fracture is stable, it's well aligned and that the ends of the fracture appose each other.  Once we've done that, we find ways to help the bone heal.  In most cases this is a variation of rest.  It could be bed rest, a cast, a fracture shoe or just decreasing activity.  As you can see, each of these methods of treatment is a variation of rest.  Most stress fractures of the foot will heal over time with  just a little help. Patients are usually surprised to find out that a stress fracture takes 8-12 weeks to heal.


Other causes of forefoot pain
   Morton's neuroma (benign tumor 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 sac often between a bone and an area of pressure)


The treatment of metatarsal fractures varies depending on the type and location of the fracture. If the fracture is due to direct trauma and the fracture fragments are well aligned then the treatment is immobilisation and non-weight bearing for 6 - 8 weeks. Immobilisation can be achieved using a plaster cast or a removable plastic pneumatic boot. The removable boot is better for a sporting individual, because the boot can be removed for physiotherapy treatment, which is aimed at preventing stiffness in the ankle joints. In addition, cardiovascular fitness can be maintained by performing non-weight bearing exercises in a swimming pool.

The same method is usually adequate for 'march' (stress) fractures of the second metatarsal and rotational fractures of the fifth metatarsal. However, stress fractures of the base of the fifth metatarsal sometimes show a poor healing capacity. For this reason, many orthopaedic consultants now favour surgical fixation. A small incision is made on the outside border of the foot and a small screw is placed down the middle of the fractured bone. With this method a return to sporting activity is usually possible after 6 - 8 weeks.