The metatarsals are the long bones in the middle of the foot. They are prone to overuse injuries, especially in running sports and dancing. Stress fractures are painful injuries to runners and dancers, and they significantly limit the athlete’s ability to participate in those sports.

Signs and symptoms of this foot injury

Usually the athlete will not remember a specific injury that initiated the symptoms. He or she will usually note pain that has been increasing as training or competition has increased. Often the athlete will say that 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.

Examination of the injured foot by a sports medicine physician usually reveals a very specific point of tenderness at the stress fracture site. There may be some swelling at this location, but often the foot looks normal. Early on in the process, even if the stress fracture is present, an x-ray can be negative. 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

The treatment of a metatarsal stress fracture is most often nonoperative. Avoiding the offending activity, protecting the foot with a boot or protective shoe, and possibly decreasing the patient’s weight-bearing status usually helps the fracture to heal without surgery. 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 a stress fracture

Prevention of stress fractures is also important to emphasize to the athlete. Athletes with osteoporosis, such as postmenopausal females, are at risk. Teenage female athletes can also be at risk for these injuries if they have 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.

Location of metatarsal stress fracture pain

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