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A Guide to understanding Stress Fractures

Stress Fractures

A Guide to understanding Stress Fractures


Metatarsal Bones


The metatarsal bones are common sites for stress fracures (25% of stress fractures).


On the left a 15-year old female with no history of trauma.


Recent onset of lateral forefoot pain with walking.


The radiograph taken at presentation is unremarkable.


Follow-up at 3 weeks shows complete fracture of the distal shaft of the 4th metatarsal with overt periosteal reaction.

  1. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23:472-481

  2. Arendt EA, Griffiths HJ. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes. Clin Sports Med 1997; 16:291-306

  3. Three previously healthy persons with a stress fracture. by J.L.Bron, G.B.van Solinge, A.R.J.Langeveld, T.U.Jiya en P.I.J.M.Wuisman Ned Tijdschr Geneeskd. 2007;151:621-6

  4. Stress fractures in the lower extremity. The importance of increasing awareness amongst radiologists. Berger, FH, de Jonge, MC and Maas, M. European Journal of Radiology 62 (2007), 16-26.


Common Foot Problems

Do I Need To See A Doctor?


   The metatarsal bones are some of the most commonly fractured (broken) bones in the foot. There are two main types of metatarsal fractures:


Acute fractures - due to an acute (sudden) injury to the foot (commonly dropping a heavy object onto the foot, a fall, or a sporting injury) –a true foot emergency.


Stress fractures - due to overuse, or repetitive, injury to a normal metatarsal bone


   A stress fracture is a small crack in a bone. Stress fractures often develop from overuse, such as from high-impact sports like distance running. But if you are a 40 year old woman and have just started a walking/exercise program, you can get them too! They can occur after new footwear, or insufficient rest, or continuing to exercise despite the presence of foot pain. Sometimes metatarsal stress fractures can occur in someone who has an underlying problem affecting the bones such as rheumatoid arthritis or osteoporosis. They can also occur in people who have lost sensation in their feet due to neurological problems, for example diabetes that has affected the nerves in the feet.

  • Pain that develops gradually, increases with weight-bearing activity, and diminishes with rest

  • Pain that becomes more severe and occurs during normal, daily activities

  • Swelling on the top of the foot or the outside of the ankle
  • Tenderness to touch at the site of the possible fracture
  • Foot bruising

   Your doctor may suggest an X-ray of your foot if they suspect a metatarsal stress fracture. However, not all stress fractures show up on X-rays initially. In fact, about half of them never show up on a normal X-ray. Most metatarsal stress fractures can be seen by using a bone scan to look at your foot.

  How Are Metatarsal Stress Fractures Treated?  

   The goal of any treatment is to help you return to all the activities you enjoy. Following your doctor’s treatment plan will restore your abilities faster and help you prevent further problems in the future.


   Rest. Take a break from the activity that caused the stress fracture. It typically takes 2-4 months for a stress fracture to heal. During that time, switch to aerobic activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. Remember, however, that you should not do any physical activity on the involved foot or ankle until you consult a doctor.


   Protective footwear. To reduce stress on your foot and leg, your doctor may recommend wearing protective footwear. This may be a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe.


   Casts. Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal. Your doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress on your involved leg. Casts are a type of external fixation. To keep weight off your foot and leg, your doctor may recommend that you use crutches until the bone heals.


LivingBody BEAUTIFUL | Your Tri-County Resource Guide to Health and Beauty | Magazine Six    9       


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