Metatarsal stress fracture

Fatigue fracture typically occurring to the second, third, fourth and fifth and then first metatarsal bones in order of frequency.





• 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


• 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



• 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.

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The first step is to determine where the affected area is on the foot, and choose the appropriate foot view below that best shows that area.

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