A metatarsal stress fracture is a fine, hairline fracture in one of the long metatarsal bones in the foot and can occur through overuse or poor foot biomechanics. The second metatarsal is the bone most commonly fractured causing gradual onset pain in the middle front of the foot. Rest is key to recovering from this foot injury.
On this page:
- Causes & anatomy
Metatarsal stress fracture symptoms
Symptoms of a metatarsal stress fracture include pain in the foot which occurs gradually over time. 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 on at the point of fracture the bone, which is painful to touch. 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.
Causes & anatomy
The metatarsals are the long bones in the foot which connect the tarsal bones in the ankle to the phalanges bones of the toes.
Metatarsal fractures can be either an acute fracture or a stress fracture. An acute fracture is caused by a direct impact or trauma such as being trodden on in football by a player wearing football boots with studs. A stress fracture occurs gradually over time from repetitive strain or overuse, for example in long-distance runners.
A metatarsal stress fracture is most likely to will involve the second, third or fourth metatarsal bones. Stress fractures to these bones are the second most common location for a stress fracture in sport, after tibia stress fracture (shin).
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 (foot pointing upwards) position, as this places greater loads 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.
Metatarsal stress fracture treatment
Rest from weight-bearing activities as much as possible. Continuing with normal training, especially weight-bearing activities will not allow the bone to begin to heal. The rest period should normally be around 4 weeks to allow sufficient healing, after which a second X-ray should be taken. This may confirm the presence of a stress fracture as it should show up as new bone growth at the point where the fracture occurred. For those whose job requires them to weight bear, a walking boot may be used to reduce the strain on the bones and soft tissues of the foot.
Recommence activities only once all pain when walking and tenderness on touch has gone. Start with a very slow return to activity and a gradual build of duration and intensity. Running mileage should increase only by 10% each week maximum.
If the metatarsal stress fracture has been caused by abnormal foot mechanics such as overpronation or oversupination then orthotics (shoe inserts) may be required to correct this.