Metatarsal Stress Fractures

What causes metatarsal stress fractures?

Metatarsal stress fractures are prevalent amongst active patients of all ages and activity levels. Stress fractures occur when there is increased stress on the bone, and the bone cannot remodel itself at an efficient rate. As a result, a small crack in the bone develops, and can be extremely painful.

The patients who present to my clinic with stress fractures have a history of a recent increase in their running mileage, or they are just starting a new exercise routine (i.e hiking, walking, Zumba). I see stress fractures in both males and females. I also see stress fractures in overweight, as well as lean individuals.

Rather than just deeming this an “overuse injury” we look for an array of factors that may have contributed to developing a stress fracture. Labs are recommended to evaluate for nutritional deficiencies, such as Vitamin D. We also evaluate your biomechanics and look for gait asymmetries.

What does a metatarsal stress fracture look like?

Clinically, a metatarsal stress fracture will present with localized swelling. There is usually a puffy area over the painful area.

X-rays can be helpful to evaluate for a stress fracture. During the initial visit, the stress fracture may not be visible. However after a couple weeks, the body will start developing a callous around the stress fracture, and this will be visible on x-ray.

An MRI or bone scan can also be used to evaluate for a stress fracture. These advanced imaging modalities are expensive, and generally unnecessary.

What does a metatarsal stress fracture feel like?

Severe pain will be localized to an area the size of a dime. You can elicit pain by pressing directly on the injured bone. Pain will be sharp in nature. You may also feel generalized pain to surrounding structures in the foot and ankle. If you develop a stress fracture during your activity, it will likely stop you in your tracks and force you to walk back to car with a limp.

If you have a gradual or sudden increase in pain, you should discontinue your activity immediately. Stress fractures may turn into complete fractures if you continue to stress the bone.

Will a metatarsal stress fracture heal on its own?

Yes! Surgery is not necessary for these types of fractures.

Icing is recommended to help with pain and swelling. Avoid NSAIDs! These drugs will delay healing. Low impact cross training is encouraged when recovering from a stress fractures. As always, let pain be your guide when choosing cross training activities.

Not all stress fractures are treated equally. A short course of immobilization is recommended. Typically this involves a protected walking boot or stiff soled shoe. Your pain will guide the treatment protocol. Rarely is complete non weight bearing with crutches necessary.