Metataral Stress Fractures

John A. Brandeisky, DPM, FACFS

Presented by:

Dr. John Brandeisky

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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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