Treating a Metatarsal Stress Fracture

x-ray image of bone fracture at 5th Metatarsal left foot
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Stress fractures are a common athletic injury, and one that can cause a great deal of pain. This type of fracture sometimes occurs in the foot, affecting the metatarsal bones. Learn how to identify a metatarsal stress fracture, its causes, and how to prevent and treat this foot injury.

What Is a Metatarsal Stress Fracture?

A metatarsal stress fracture is a fracture to one of the metatarsal bones—the long bones in the foot that connect your heel and arch to your toes—and occurs due to repeated stress or injury. This is different from an acute fracture, which is when you break a bone suddenly due to an accident, fall, or collision.

After the tibia, the metatarsals are the most common bones to develop stress fractures in the lower limb, with a majority of these fractures occurring in the second and third metatarsals.

There are five metatarsal bones in total and they are numbered based on their position in the foot. For instance, the first metatarsal is the long bone closest to the inside of the foot, connecting to the big toe. The fifth metatarsal is closest to the outside of the foot, connecting to the little toe.

Research has found that females are over three times more likely to experience stress fractures than males. Age plays a role as well, with fractures to the fifth metatarsal more common in males at younger ages, then becoming more common in females as age progresses.

People participating in certain sports or activities tend to endure stress fractures in their feet more frequently. This includes runners, people engaging in sports that involve jumping (like basketball and dancing), and even military recruits.

Causes and Risk Factors

Metatarsal stress fractures have many potential causes. One of the most common is a sudden increase in the intensity and/or volume of your training, or training at a level that is above your fitness level.

Running long distances or for long periods of time can lead to these injuries as well (especially if you're not wearing the right shoes or running on a surface that doesn't help absorb the shock). The high training volume stresses the metatarsal bones, potentially causing them to fracture.

A biomechanical flaw, either in your running form or body structure, can also lead to a metatarsal stress fracture by placing more load on certain parts of your foot. This is partially why proper form is so important—it helps reduce your injury risk.

Additional factors that can increase your risk of developing a stress fracture in the long bones in your feet are:

Symptoms

Pain in your foot can be an early sign of a metatarsal stress fracture. This pain may occur while running but go away with rest, and you may feel it over a specific area on your foot.

If it progresses, you may feel the pain all the time, even when you're not running. The area of the fracture may be tender when you touch it. It may also be swollen.

Treatment

If you suspect a metatarsal stress fracture, stop running immediately and see a doctor. Early diagnosis is critical because the injury can worsen if not allowed to heal and, in some cases, become a complete fracture of the bone.

Your healthcare provider can perform an x-ray, which may show a crack. However, stress fractures sometimes don't show on an x-ray, so an MRI or bone scan may be necessary.

If a stress fracture is confirmed, depending on its severity, you may need to wear a special shoe to support your foot during the healing process or a cast below your knee. This type of injury can take anywhere from 4 to 12 weeks to heal.

Rest, anti-inflammatories, stretching, and muscle strengthening are additional treatment options. So is eating 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.

Prevention

A 2020 study identified two ways to help prevent stress fractures. They are to engage in daily running before joining a dedicated training program and consuming milk regularly, the latter of which is may be due to increasing calcium and vitamin D.

For metatarsal stress fractures specifically, make sure you're wearing the right shoes for your foot and running style. Additionally, replace those shoes every 300 to 400 miles to ensure that they continue to support your feet during your regular runs.

As far as exercise is concerned, if you want to prevent a metatarsal stress fracture yet still stay active:

  • Don't increase your weekly mileage by more than 10% each week (called the 10% rule).
  • If you're training for a long-distance race, decrease your weekly mileage every three to four weeks to give your body a break.
  • Cross-train to build your strength in other areas while preventing you from putting too much stress on your feet.

A Word From Verywell

A stress fracture is not the type of injury that you can run through. It's serious and could get worse if you keep running. Seek medical attention if you think that you may have a stress fracture to a metatarsal bone.

Also, when you restart an activity after a metatarsal stress fracture, build up slowly. Check with your doctor or physical therapist to guide you on how to safely return to running. If your foot begins to hurt, stop and take another rest day.

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