Metatarsal stress fractures are a common occurrence and generally are first recognized by swelling on top of the foot close to the toes and pain most pronounced to the top of the foot during lifting the heel off of the ground while walking
A stress fracture is a “break” in a bone related to repeat stress to the bone over a longer period of time that causes the bone to fatigue and eventually “break”. Many fractures are caused by high energy injuries like for example, dropping a brick on the top of the foot. Stress fractures however occur from lower energy injuries occurring over a longer period of time that exceeds the bones ability to resist injury.
The stress fracture may present without any injury or even increase in activity. Injury to the metatarsal may be as simple as a day’s walking activity in poorly supportive shoes like loafers. Injury to the second metatarsal bone is most common and generally is related to its relative increase length and pressure during walking.
X-rays early in stress fractures most commonly don’t show where the fracture is but an MRI can help establish a diagnosis. MRI’s are usually not needed because a careful examination revealing pain to palpation at the involved metatarsal and swelling to the top of the foot help establish the diagnosis.
Early treatment will help relieve pain and allow healing. Limitation of activity is not enough to decrease stress through the metatarsal. Immobilization with a post surgical shoe but better yet, the use of a removable cast boot or CAM walker for a three to four week period of time preferable is generally enough to allow healing.
Re-injury prevention can be hastened with the use of supportive shoes and orthotics that assist in reducing some of the injurious pressures that occur during walking.