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Metatarsal Stress Fracture
When excessive stress is placed upon the ball
of the foot, a hairline break (fracture) of a long metatarsal bone may
occur. This occurs most frequently to the second, third, or fourth
metatarsal but can occur in any bone. Frequently, the injury is so
subtle that you may not recall any specific occurrence. These fractures
were at one time referred to as "March Fractures" in soldiers, who
developed foot pain after long periods of marching. Stress fractures
can occur during sports activities, in overweight individuals, or in
those with weakened bones such as osteoporosis. Diagnosis A
typical presentation for someone with a metatarsal stress fracture
would be pain and swelling in the ball of the foot, which is most
severe in the push off phase of walking. Pressing on the bones in this
area of the foot will reproduce the pain. X-rays taken during the first
two to three weeks after the injury often will not show any fracture. A
bone scan at this stage will be much more sensitive in diagnosing the
early stress fracture. The decision to order a bone scan will be up to
your doctor. Often times the diagnosis can be made based upon clinical
findings, thus making the bone scan unnecessary. After several weeks,
an x-ray will show the signs of new bone healing in the area of the
stress fracture. Treatment Treatment
for a metatarsal stress fractures usually consists of rest, elevation,
and ice initially. Sometimes a compression bandage is applied to help
reduce the swelling. Frequently a post-operative type shoe or
cam-walker is used to prevent you from pushing off the ball of your
foot, thus eliminating any additional stress while the bone is healing.
Occasionally a short leg walking cast may be applied for a short period
of time. Typical healing times range from 4 to 8 weeks. After the
fracture is healed, special attention should be paid to using a
well-padded insole or a functional orthotic
in the shoes to reduce the stress in this area. For those who may have
osteoporosis, bone densitometry testing should be done, and appropriate
treatment initiated to prevent further weakening of the bones.
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