Metatarsal Stress Fractures - Symptoms and Treatment Options
How can I tell if I have a metatarsal stress fracture?
Patients are always surprised when I tell them that they have a metatarsal stress fracture. When we hear the word fracture, we're naturally programmed to go back into our last few days or weeks and do a rundown on our activities. Patients ask themselves "when did I injure my foot?" I don't remember twisting it or turning it in any way. But the reality of a metatarsal stress fracture is that the onset of a metatarsal stress fracture is not from acute trauma but rather from increased and unsustainable load applied to the metatarsal bone. Here are a few examples of how my patients have recently described the onset of their metatarsal stress fracture:
"I've been training for a triathlon and have been doing really well keeping to my training schedule. I order a new pair of shoes and started using them last week. I used them for two days and my left forefoot got a little sore. When I tried to get up out of bed last Thursday, I could hardly put weight on my left foot."
"I wanted to try a pair of minimalist shoes, so I tried a pair on my treadmill. I liked the feel and increased my time on the treadmill but started to feel a little burning in my right forefoot. Now I can't even walk."
"I was late for a flight at O'Hare. I grabbed my bag and had to run for my flight. I made the flight but once I got on the plane I noticed a sore spot in the ball of my foot."
Metatarsal bones are the long bones that extend from the midfoot to the ball-of-the-foot, descending at about a 35-degree angle. In an ideal world, each of the metatarsal bones would support the foot, carrying a proportionate amount of load. But in cases of metatarsal stress fractures, load-bearing by the metatarsal bones is eccentric and results in loading of one metatarsal bone with loads that it cannot sustain. The result is unsustainable bone fatigue and a stress fracture.
Symptoms of a metatarsal stress fracture include:
- Mild firm swelling specific to the fracture site
- Limited erythema (redness) and bruising
- Site-specific pain with initial weight bearing. Pain increases with duration of time on the feet.
The diagnosis of a stress fracture is confirmed only by symptoms and cannot be seen by x-ray in the first 3-4 weeks of healing. At 4 weeks, a cloud of bone called bone callus forms. Bone callus is the internal cast used by your body to stabilize the metatarsal stress fracture. Visualization of bone callus at 4 weeks following the onset of the fracture is the earliest time that metatarsal stress fractures can be confirmed on x-ray. Us of an x-ray is helpful to determine the alignment and apposition of a fracture. Good alignment and apposition is essential for successful healing.
Treatment of metatarsal stress fractures requires rest and a decrease in activities. Remember the acronym RICE-
Treatment of metatarsal stress fractures requires immobilization and limited activity. In addition to ice and elevation, the following products can help-
Be sure to check our complete knowledge base article on metatarsal fractures for more information on these unique fractures of the foot.