Metatarsal Stress Fracture
What is it?
There are five metatarsal bones in each foot. Stress fractures are incomplete breaks of the bone. A stress fracture of the metatarsal typically occurs over time with excessive weight bearing activity such as running, sprinting, jumping or dancing. It is commonly associated with changes in the intensity of activity (i.e. sudden increase of activity) or changes in the training conditions (such as footwear, surfaces etc). It may also be caused traumatically such as a poor landing from a jump in dancers or landing from a height. Poor calf muscle strength can cause excessive forefoot loading and fatigue of these muscles in dancers may contribute to the development of this condition. It commonly affects the 2nd and 5th metatarsals.
The common symptom is pain over the forefoot and it is aggravated by activity such as dancing or running. The pain may not be severe initially but generally worsens with activity. Swelling may be a symptom but will not present in all cases.
The management of stress fractures requires a rest period from weight bearing aggravating activities for 6-8 weeks. In the initial phase of treatment an offloading walker is used for two to four weeks. Low level laser therapy may be useful in reducing pain, swelling and increase bony remodeling. Orthotic therapy may be required to help reduce abnormal load from poor foot mechanics. Exercises to improve the function of the intrinsic and extrinsic foot muscles may help to prevent recurrence.