Stress Fractures – Metatarsals: Causes, Symptoms, and Treatment

What Are Metatarsal Stress Fractures?

A stress fracture is a small crack in a bone caused by repetitive strain. The metatarsal bones—five long bones connecting the midfoot to the toes—are especially prone to stress fractures due to their role in weight-bearing and propulsion during movement.

Stress fractures typically develop gradually, often as a result of cumulative overuse, and are distinct from acute fractures caused by sudden trauma.

Causes of Metatarsal Stress Fractures

Overuse and Repetitive Activity

• High-impact sports such as running, basketball, or tennis.

• Sudden increases in training intensity, frequency, or duration.

Biomechanical Factors

• Foot Mechanics: Conditions like flat feet (pes planus) or high arches (pes cavus) can unevenly distribute forces across the metatarsals.

• Gait Abnormalities: Poor running technique or excessive pronation.

External Factors

• Inappropriate or worn-out footwear lacking proper support.

• Training on hard or uneven surfaces.

Bone Health

• Osteopenia or Osteoporosis: Reduced bone density increases susceptibility.

• Nutritional Deficiencies: Inadequate calcium or vitamin D levels.

Symptoms of Metatarsal Stress Fractures

• Forefoot Pain: Dull or sharp pain that worsens during activity and improves with rest.

• Localized Tenderness: Pain when pressing over the affected metatarsal.

• Swelling: Mild swelling over the top of the foot.

• Activity-Related Pain: Symptoms may initially appear only during exercise but progress to constant discomfort if untreated.

Diagnosis of Metatarsal Stress Fractures

Clinical Examination

• Assessment of pain, tenderness, and swelling.

• Gait and biomechanical analysis to identify contributing factors.

Imaging

• X-rays: May not show early stress fractures.

• MRI or Bone Scans: Effective in identifying stress fractures at an early stage.

Treatment for Metatarsal Stress Fractures

Non-Surgical Management

1. Activity Modification

   • Avoid weight-bearing activities that worsen symptoms.

   • Use of crutches or a walking boot to immobilize the foot and promote healing.

2. Physiotherapy

   • Rehabilitation Exercises: Focused on strengthening the foot and lower leg muscles.

   • Stretching: Calf and foot stretches to alleviate strain.

   • Gait Retraining: Correcting biomechanical abnormalities to prevent recurrence.

3. Orthotics

   • Custom insoles to redistribute pressure and improve foot mechanics.

4. Pain Management

   • Use of non-steroidal anti-inflammatory drugs (NSAIDs) if needed, under medical guidance.

Surgical Management

Surgery is rarely needed but may be considered for:

• Non-healing stress fractures.

• Severe fractures or those involving significant displacement.

Recovery Timeline

• Initial Healing: 6–8 weeks of reduced weight-bearing and immobilization.

• Rehabilitation Phase: Gradual return to activity over the next 4–12 weeks.

• Full Recovery: 3–6 months, depending on the severity of the injury and adherence to treatment.

Preventing Metatarsal Stress Fractures

• Gradually increase exercise intensity to avoid overloading.

• Wear supportive and appropriate footwear for your activities.

• Cross-train to reduce repetitive stress on the same area.

• Maintain bone health with a balanced diet rich in calcium and vitamin D.

At Palms Physiotherapy & Allied Health, our team is dedicated to providing expert care for metatarsal stress fractures, supporting your recovery and long-term foot health. Contact us today to begin your tailored treatment plan.