How to Prevent, Identify, and Treat a Metatarsal Stress Fracture

Metatarsal bones are the long bones in your foot that connect your ankle to your toes. A stress fracture is a tiny break in the bone that happens with repeated injury or stress. With runners, metatarsal stress fractures are caused by running (usually too much, too soon) and overly stressing your foot.

Pain in your foot is an early sign of a metatarsal stress fracture. The pain may occur while running but go away with rest. You may feel it over a wide area of your foot. Over time, you'll feel the pain all the time, even when you're not running. The area of your foot where the fracture is may be tender when you touch it. It may also be swollen. Early diagnosis is critical because the injury can spread and eventually become a complete fracture of the bone.

Like stress fractures in other areas of the leg, metatarsal stress fractures most frequently happen when runners increase the intensity and volume of their training over several weeks to a few months. A shortage of calcium or a biomechanical flaw -- either in your running style in or your body structure – may also contribute to the injury. Those with a bone condition such as osteoporosis (thin, weak bones) or arthritis (inflamed joints) are at greater risk for metatarsal stress fractures.

Make sure you're wearing the right shoes for your foot and running style. Get a gait analysis at a running shop. Replace your shoes every 300-400 miles to make sure you're not running in worn-out shoes. Don't increase your weekly mileage by more than 10% each week. If you're training for a long-distance race, go down in your overall weekly mileage every 3-4 weeks to give your body a break. Take days off from running and cross train to avoid putting too much stress on certain areas of your body.

Make sure that you're doing a proper warm-up, doing a slow jog or walk for five minutes and warm-up exercises, before you start running. Finish with an easy cool down run for five minutes and stretching.

Eat a healthy, balanced diet and make sure you're getting enough calcium and vitamin D (necessary for calcium absorption). Talk to a doctor about whether you should be taking any supplements. Avoiding carbonated beverages, alcohol and tobacco help to reduce the risk of low bone mineral density.

If you have symptoms of a metatarsal stress fracture, you should stop running immediately and see a doctor. He or she can perform an x-ray which may show a crack. However, stress fractures sometimes don't appear on an x-ray, so an MRI or bone scan may be necessary to diagnose it. Keep in mind that you need to get a proper diagnosis for a stress fracture; don't try to self-diagnose.

Your injury may take anywhere from 4 to 12 weeks to heal, and depending on the severity of the stress fracture you may need to wear a special shoe to support your foot. If your pain is severe, you may have a cast below your knee.

Don't mess around with a stress fracture -- it's not the type of injury that you can run through. It's serious and could get worse if you continue to keep running. Rest, anti-inflammatories, stretching, and muscle strengthening are recommended treatments. Cross-training and water-running are possible alternatives to running while you're recovering. Make sure you eat a nutritious diet, since improper nutrition, especially a lack of calcium, may slow healing.

You can return to running when you can run without pain. When you restart an activity after a stress fracture, build up slowly. If your foot begins to hurt, stop and take another rest day.

_Sources:

_{Bennell, K. L.; et al. "Risk factors for stress fracture in track and field athletes: a twelve-month prospective study." American Journal of Sports Medicine 24 1996, 6 (810-818).}

_{Lappe, J.; et al. "Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits." Journal of Bone and Mineral Research 2008, 23 (5), 741-749.}

_{"Metatarsal Stress Fractures - Aftercare" MedlinePlus, U.S. National Library of Medicine}

_{"Stress Fractures", American Orthopaedic Foot & Ankle Society}

_{"Stress fractures", MayoClinic.com}