Stress Fracture of the Metatarsal Bones

There are five long bones in your forefoot, called the metatarsal bones; they differ in length and density and connect the toe bones (phalanges) to the heel bones (tarsals).

In most people, the second metatarsal bone is the longest and thinnest – and, as a result, the easiest to fracture.

A 2022 study by Scielo revealed that metatarsal fractures account for 9% of stress fractures affecting the lower limbs. Not just that, they have been found to be more common in women.

This article explains what stress fracture of the metatarsal bone is, what causes it and how it can be treated.

Metatarsal Stress Fracture Explained

A stress fracture of the metatarsal bones refers to an incomplete crack or fracture in one of the five metatarsal bones. Although the second metatarsal bone is the easiest to fracture, any of these bones can be affected.

Metatarsal bone fracture typically occurs when your foot handles greater pressure than it can handle or repeated stress or force.

More so, the fracture occurs because the stress or pressure placed on your foot has exceeded the bone’s ability to regenerate. A metatarsal bone fracture is common in athletes and those who get involved in high-impact activities.

Fun Fact: Did you know that strenuous activities cause micro damage or microfractures to your bones? Thankfully, these microfractures are repaired through a process called remodelling. But what happens when the body has little to no time to carry out the remodelling process? A stress fracture!

Metatarsal Stress Fracture Causes

Many things can cause stress fractures in the metatarsals, including tight or inappropriate footwear.

The fracture is caused by the metatarsals being stressed due to an imbalance between bone damage and formation. That is, if the metatarsal is stressed, the bone areas can get damaged, in which case they are removed and replaced through remodelling.

However, the time it takes for new bones to rest, form or get repaired may not be sufficient, especially when strenuous activities are repeated at short intervals.

As a result, weak points are formed at stress areas, and microdamages accumulate, resulting in a stress fracture, particularly if the stress continues.

Factors that can contribute to a stress fracture development in the metatarsals include change in training, running on hard surfaces, and poor leg positioning.

Metatarsal Stress Fracture Symptoms

The major symptom of a metatarsal stress fracture that you may experience is a gradual worsening of pain on the top of your foot.

Other symptoms include:

• Ache or Pain – This pain starts and worsens during physical activity, and it does not get better even after you stop. As time goes on, the pain in the foot becomes more noticeable when you are resting.
• Tenderness – The affected bone or areas around it can feel tender, even if you’re only touching lightly.
• Swelling – You may experience swelling in the foot or even bruising, although this is uncommon.
• Weakness – Weakness of or inability to bear weight on the affected foot is a common symptom of metatarsal stress fractures.

Metatarsal Stress Fracture Treatments

Your physician or podiatrist will first need to diagnose the condition using X-rays, MRI, whole body bone scan, or CT scan.

The tests will help them determine the location of the fracture as well as the severity of the symptoms. Using their findings, they can prescribe the best treatments for your metatarsal stress fracture.

Generally, however, the common stress fracture treatments include:

• Rest – Stop the activity that caused the fracture in the first place, and rest the leg. Furthermore, you need to stop all activities that require you bearing weight until the bone heals.
• Icing and Crutches – While resting, apply a cold pack or ice to the injured area for ten to fifteen minutes every two to three hours. Also, you will need to use crutches to protect the bone or boot to relieve the stress.
• Pain Relievers – Your healthcare provider may prescribe anti-inflammatory medications such as ibuprofen, acetaminophen, or naproxen, with instructions on how to take them. They may also recommend over-the-counter medicines like lidocaine patches to numb the surrounding area of the fracture.
• Elevation – Try to keep the injured bone elevated above the heart level as often as possible. For example, if the fracture is in the foot, use cushions when lying down to prop the leg up.
• Rehabilitation – You may want to consider booking a rehabilitation session with an athletic trainer or physical therapist who can guide you with the right flexibility and strengthening exercises. This is intended to aid you in recovery and minimise future foot injuries.
• Metatarsal Protection – Certain products such as metatarsal pads and specific insoles are designed to protect and cushion the metatarsal region.