Stress Fractures

A stress fracture is a break in a bone caused by repetitive stress. A stress fracture can occur in any bone, but is commonly found in the 2nd and 3rd metatarsal bones of the foot. You can suddenly develop a painful forefoot after some activity, such a walking, running, or squatting onto the ball of the foot. A small crack develops in the cortex (outer shell) of the bone. A stress fracture can progress to a complete or overt fracture of the bone. Metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.

Symptoms

  • Sharp pain in the forefoot, aggravated by walking

  • Tenderness on palpation of the top surface of the metatarsal bone.

  • Diffuse swelling of the skin over the forefoot.

  • Bruising or redness of forefoot

Causes

  • Decreased density of the bones due to osteoporosis

  • Unusual stress on a metatarsal due to a compensation of a forefoot deformity such as a bunion

  • Abnormal foot structure such as a flatfoot

  • Increased levels of activity without sufficient rest period

  • Obesity

If you suspect you have stress fracture you should:

  • Seek medical treatment as soon as possible

  • Keep weight off your foot

  • Ice the top surface of your forefoot for about 20 minutes every hour.

  • To reduce swelling, wrap your foot in a tensor bandage with moderate compression.

  • Wear a shoe with a very stiff sole

The medical treatment for a stress fracture may include:

  • X-rays

  • Bone scans to establish a diagnosis

  • Offloading of stress on the metatarsal with the application of taping and padding

  • Splinting and bracing of the foot with a removable below knee Aircast™.

  • Non-steroidal anti-inflammatory medication.

  • Physical therapy modalities in the later stages of healing.