Do I have a metatarsal stress fracture?

What is a metatarsal stress fracture? This article explores the onset, symptoms and treatment options for metatarsal stress fractures.

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-

• rest
• ice
• compression
• elevation

Treatment of metatarsal stress fractures requires immobilization and limited activity.  In addition to ice and elevation, the following products can help-

• forefoot compression sleeve
• arch binder
• fracture shoe (aka post-op shoe/surgery shoe)
• spring plate

Be sure to check our complete knowledge base article on metatarsal fractures for more information on these unique fractures of the foot.

Jeff  

Jeffrey A. Oster, DPM 

Medical Advisor
Myfootshop.com  

Updated 4/22/2021

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