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Metatarsal Stress Fracture

Metatarsal Stress Fracture

Stress fractures are tiny cracks in a bone caused by overuse and repetitive force. This differs to an acute fracture which occurs from a one time injury – such as a nasty ankle sprain resulting in an acute fracture of the ankle bone.

Stress fractures are more common in the weight-bearing bones of the lower leg and foot – in particular the tibia, calcaneus (heel bone) and the 2nd metatarsal.

The 2nd metatarsal is the most common metatarsal to get a stress fracture, because it is often the longest metatarsal which cops most of the stress during toe off.

Sign and Symptoms 

> Initially you may not notice much pain but this worsens with time
> Pain is worse with increased activity
> Very focal pain and sometimes swelling over site of stress fracture
> Can experience pain and throbbing at night time (good indicator of stress fracture)

Causes

Stress fractures often result from increasing the type, frequency or intensity of an activity too quickly – hence it is an overuse injury.

Bone is in a constant state of turnover – a process called bone remodelling. New bone develops and replaces older bone. If a person’s activity is suddenly increased, the break down of older bone occurs more rapidly and may outpace the body’s ability to make new bone to replace it. As a result, the bone weakens and becomes vulnerable to stress fractures.

Other Risk factors include
  • Increased activity (as mentioned above). Stress fractures often occur in people who suddenly shift from a sedentary lifestyle to an active training regimen or who rapidly increase the intensity, duration or frequency of training sessions.
  • Certain sports such as running, basketball, tennis, dance or gymnastics which are high impact and repetitive.
  • Certain foot postures may increase risk of stress fractures. A pronated foot (collapsed arch) results in 1st metatarsal and big toe dorsiflexing resulting in the 2nd metatarsal being subjected to more load. A short first metatarsal also overloads the 2nd metatarsal.
  • Women, especially those who have abnormal or absent menstrual periods, are at higher risk of developing stress fractures.
  • Bone insufficiency - Conditions that decrease bone strength and density, such as osteoporosis, and certain long-term medications like prednisone can make you more likely to experience a stress fracture, even when you are performing normal everyday activities.
  • Previous stress fractures - Having had one or more stress fractures puts you at higher risk of having more.
  • Lack of nutrients - Eating disorders and lack of vitamin D and calcium can make bones more likely to develop stress fractures.
Complications

Some stress fractures don't heal properly, which can cause chronic problems. If underlying causes are not taken care of, you may be at higher risk of additional stress fractures, or the stress fracture may worsen and become an acute fracture.

Treatment

> Immobilisation to allow the fracture to heal, which may involve a moon boot, stiff soled shoe etc.
> Activity modification such as swimming instead of running.
> Address underlying biomechanical issues which increased risk of stress fracture developing
> Graduated return to exercise