A metatarsal stress fracture is a stress fracture of one of the five metatarsal bones in the foot. Typically, this injury is an overuse injury in a running athlete. Often the stress fracture can be treated by a short-term elimination of running and other repetitive impact on the foot.
Common mechanism of injury of a metatarsal stress fracture
Usually the patient will not remember a specific injury that initiated the symptoms. You might notice pain that has been increasing as training or competition has increased. Often the pain comes on after a certain amount of time and goes away with rest. As the problem gets worse, the pain often starts earlier and earlier in the training session, and often the pain will continue despite rest from the activity. As it gets even more serious, progressing to a stress fracture, activities of daily living, such as walking, become painful.
The doctor’s exam and x-rays
Examination of the injured foot by a sports medicine physician usually reveals a very specific point of tenderness at the stress fracture site – in this case along the long bones in the foot. There may be some swelling at this location, but often the foot looks normal.
An x-ray can be negative in the weeks after the pain starts. If the physician is fairly concerned about the possibility of a stress fracture, he or she may order a bone scan or MRI. He or she might also choose to wait for several weeks and restrict the athlete’s activities. Several weeks later the physician would repeat the x-rays and determine if a stress fracture is present at that point.
Treatment of a metatarsal stress fracture
Most metatarsal stress fractures heal without surgery. Avoiding the offending activity, like running, is crucial. Protecting the foot with a boot or protective shoe can help. Occasionally putting the patient on crutches is necessary to decrease the pain.
Depending on the location, though, some fractures might require surgical treatment. The most common metatarsal stress fracture for which surgery is recommended is one at a specific location on the fifth metatarsal, which is the metatarsal toward the outside of the foot. Surgery for these fractures usually involves placing a screw inside the bone. This surgical treatment is especially advocated for fifth metatarsal fractures in soccer players and other high-level athletes.
Prevention of stress fractures is important as well. Postmenopausal women and young female athletes are at risk if they have poor bone density. This fact is especially true if the teenage athlete has poor nutritional status and menstrual irregularities. Assessment of bone mineral density with tests such as DEXA scans are important in these athletes as well as athletes with a history of prior stress fracture.
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