Metatarsal stress fracture
Fatigue fracture typically occurring to the second, third, fourth and fifth and then first metatarsal bones in order of frequency.
Symptoms
• Achy pain that get progressively worse as the day advances
• Limited pain with initial weight-bearing when standing from a sitting position
• Swelling noted to the top of the foot just behind the metatarsal joints
• Localized pain to direct palpation in the area of the fracture
Radiology
• Regular x-rays can show early changes consistent for a stress fracture at a minimum of two weeks from the onset of symptoms; Reaction to the outside of the metatarsal bone called periosteal reaction can be seen at two weeks
• As fracture advances a break can often times be noted on x-ray
• MRI can be used if needed to confirm the diagnosis
Treatment
• Immobilization in removable cast boot (CAM boot) for three to four weeks
• Compliant use of CAM boot for all weight bearing activity during healing
• Slow return to supportive shoe with possible temporary orthotic to offload the ball of the foot to ensure adequate bone healing
• Recommendation for stiff sole shoe to decrease bending forces at the metatarsal bones.
