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A stress fracture is a break in a bone cause by repetitive
stress. It may occur in any bone, but is quite common in the metatarsal
bones of the foot. There is often no recollection of injury. The patient
may simply develop a painful forefoot after some activity, such a
walking, sports, or stooping down onto the ball of the foot. A small
crack develops in the cortex (outer shell) of the bone. Without proper
treatment, this may progress to a "through and through"
(overt) fracture of the bone. The second and third metatarsals are
the most commonly affected. Metatarsal stress fracture may not become
apparent on x-rays until a few weeks after the injury.
Symptoms
Sharp pain in the forefoot, aggravated
by walking
Tenderness to pressure on the top surface of a metatarsal bone.
Diffuse swelling of the skin over the forefoot.
Causes
Decreased density of the bones
(e.g. osteoporosis)
Unusual stress on a metatarsal due to malposition or another forefoot
deformity (e.g. bunion)
Abnormal foot structure or mechanics (e.g. flatfoot)
Increased levels of activity, especially without proper conditioning
Obesity
What you can do
Seek professional help as soon as possible
Keep weight off the foot
Ice the top surface of the forefoot for about 20 minuets every
hour.
To reduce swelling, wrap the foot in a tensor bandage with moderate
compression.
Wear a shoe with a very stiff sole.
What the doctor may do
Take x-rays to look for fracture
Order special diagnostic bone scans to establish a questionable
diagnosis
Apply orthopedic taping and padding to relieve stress from the
metatarsals.
Dispense a surgical/ trauma shoe to splint the foot.
Prescribe medication for pain and inflammation.
Use physical therapy in the later stages of healing.
Occasionally a plaster cast is necessary.
Other causes of forefoot
pain
Morton's neuroma (benign tumor of a nerve running between
the
metatarsals)
Metatarsalgia (painful and inflammation of the metatarsal
bones and their
soft tissue sheath)
Capsulitis (painful and inflammation of the joints
between the metatarsal
bones and toes)
Tendonitis (inflammation of the tendons which course along the
top of the
foot)
Dislocation of a joint between a metatarsal and a toe (metatarsal-phalangeal
joint)
Severe plantar callus (callus on bottom of the foot) or bursitis
(an inflamed
fluid-filled sac often between a bone and an area of pressure
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