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Metatarsal Stress Fracture explained by San Francisco Podiatrist and Runner

A metatarsal stress fracture is a crack or break in one of the five metatarsal bones found in the foot. Sometimes these fractures will cause pain in the ball of the foot. A suspected stress fracture warrants an evaluation by a foot fracture specialist, even if initial treatment has been started in the emergency room. Runners and triathletes should stop any activity until they make sure the bone isn't broken.

Stress fractures are very small cracks in the bone. These tiny, hairline breaks are most often caused by repetitive stress. We see this most often in runners and triathletes. The main culprit is a rapid increase in mileage while training for long distance events. Stress fractures are also caused by osteoporosis, abnormal foot structure (such as high arches), or other foot deformities. Overstriding or running with a long stride can also lead to stress fractures. Wearing the right shoes for your foot type is critical. You must choose the right shoes for your foot type in order to prevent stress fractures. If you suspect a stress fracture, stop running and don’t ignore it. They can worsen if left untreated. You might also be at risk for a pattern of recurring future injury. 


You might have a metatarsal stress fracture if you notice any of the following symptoms: 

• Pain either during or after normal activity.

• Pain which goes away while resting, but returns when standing or walking.  

• “Pinpoint tenderness” (pain or tenderness right at the site of the suspected fracture) when touched 

• Swelling without any bruising 

• Bruising in the aching area of the foot 

Sprains and fractures can have very similar symptoms. But often with a sprain, a broader area of the foot will ache, rather than just a certain point of tenderness. We can easily diagnose the problem and start you on the appropriate treatment. This will help you get back to your activities as fast as possible. Keep in mind that some sprains and dislocations can be severely disabling. Without the right treatment you can develop crippling arthritis. 



Potential Problems of Improper Fracture Treatment 

We often see people in the office who will say “I thought that there isn’t anything that can be done for a broken bone in the foot.” This is false. In fact, if a fractured phalanx bone in the toe or a metatarsal bone in the foot is not treated correctly, you can develop serious problems. For example: 

• A permanent deformity in the bone alignment and structure can develop and limit the ability to walk on the foot or even fit into shoes. 

• Arthritis is often caused by an untreated fracture that involves a break in the joint surface. In some cases, when the bone isn’t realigned, an angular deformity develops and causes problems.  

• Chronic foot pain and long-term difficulties with walking.

• Non-union,or failure of the broken bone to heal, which can lead to a need for surgery or suffering from chronic pain. 


Metatarsal Stress Fracture Treatment 

Metatarsal fractures can be caused by repetitive stress (a small amount of force applied over and over for a very long time) or trauma (a whole lot of  force applied all at once).  The risk for long-term problems after a metatarsal fracture depends on which of the five metatarsal is broken, and where the break occurs. For example, a break in the first metatarsal bone (the one behind the big toe joint) can lead to painful stiffness and arthritis. The big toe is used frequently and the big toe joint carries about half of all of the force on the forefoot when you walk. If you develop arthritis in the big toe joint, it cane become painful to walk, bend, or just stand on the foot. There is another worrisome injury called a Jones fracture, which involves the base of the fifth metatarsal bone (the one behind the little toe joint). Jones fractures are often misdiagnosed as an ankle sprain. A misdiagnosis and lack of proper treatment can lead to serious problems since sprains and fractures are treated differently. Make sure you see an expert.

The best treatment of a metatarsal fracture will depend on the specifics of the fracture, but may include: 

• Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone. 

• Avoid the activity that led to the fracture. Stop running, cycling, and hiking until you get checked out.

It is important to make sure that you don’t injure the area further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches of a wheelchair in order to allow it to heal. Try to choose a foot fracture expert who understands the activities you enjoy so you can stay active while you heal.

• Immobilization, casting, or stiff shoe. A cast, stiff shoe or fracture walking boot might be needed to protect and stabilize the fractured bone while it is healing. 

• Surgery. Depending upon the extent of the injury, some metatarsal fractures will heal much better with surgery to re-align and stabilize the bone. 

• Follow-up treatment. You will receive very particular instructions for treatment after both surgical and non-surgical metatarsal fracture treatment. Physical therapy, strengthening exercises and rehabilitation can help get you back to your athletic activities as quickly as possible.  

Dr. Christopher Segler is a Runner and Ironman triathlete who practices Podiatry in San Francisco. Because of his involvement in triathlon and marathon running, he attracts patients who are athletic and goal oriented. He enjoys helping these patients get back to running as quickly as possible. 



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