A metatarsal stress fracture is a fine fracture in one of the long metatarsal bones in the foot. A stress fracture can occur through overuse or poor foot biomechanics. The second metatarsal is the most commonly fractured and will often cause pain in the middle front of the foot. Rest is key to recovering from this foot injury.
Symptoms include pain in the foot which occurs gradually. The pain will be located towards the middle or front of the foot and is made worse by weight bearing activities such as walking, running or dancing. There may be a specific tender spot which is painful to touch at the point of fracture.
Swelling is often present, although an X-ray will often not show the fracture until two or three weeks after it has started to heal.
Metatarsal fractures can be either an acute fracture or a stress fracture. They can be fractured through impact for example a vicious football stud (acute fracture), or through a more gradual onset, where repetitive impact causes a stress fracture.
This usually will involve the second, third or forth metatarsal bones. Stress fractures to the metatarsals are the second most common location for a stress fracture, after the Tibia.
The most common position for a metatarsal fracture is the second metatarsal, especially in those whose second toe is longer than their big toe. It is also more common in those who overpronate with the first metatarsal in a dorsiflexed position as this places greater load on the 2nd metatarsal.
Stress fractures in the other metatarsals are less common, although they do occur.
Causes of stress fractures include:
- Too much training, too soon without enough rest!
- They are common in army recruits (often called a march fracture), runners, ballet dancers and gymnasts.
- Rest from weight bearing activities as much as possible.
- For those whose job requires them to weight bear, a walking boot may be used.
- The rest period should normally be around 4 weeks to allow sufficient healing.
- Recommence activities only once all pain on touch and walking have cleared.
- Start with a very slow return to activity and a gradual build of duration and intensity.
- If the stress fracture may have been caused by abnormal foot mechanics such as overpronation or oversupination then orthotics may be required to correct this.