Stress fractures of the metatarsals are very common, and I most commonly see them in runners, those playing recreational sport, and females. Excessive loading of the forefoot is thought to be the main contributing factor. Due to its anatomy and position, the second metatarsal is the most common location for a stress fracture in the forefoot.

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Clinical Features

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Forefoot pain which is aggravated on weight bearing such as when standing, walking or running. Pain tends to worsen with increasing intensity or duration of activity. The metatersal will be tender to the touch and swelling, redness and localised warmth may also be present.

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Investigations

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Xrays may show bony changes if the fracture has been present for a few weeks. If xrays are negative, a bone scan or MRI may confirm the diagnosis.

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Treatment

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Stress fractures require total rest from weight -bearing activities for around 4 weeks. A CAM walker (also known as a moon boot) is commonly prescribed to help reduce pressure under the forefoot whilst the person is standing or walking.

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It's vital to address any underlying factors to ensure timely healing and the prevention of future injury. These can include biomechanics, training loads and general health. I often recommend input from a Sports Physician to consider these wider health factors. In the event of a more complicated fracture referral to a surgeon may be required.

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The person should be allowed to recommence activity when there is no pain when walking and there is no local tenderness at the fracture site. A graduated exercise program should be instituted under the guidance of a health professional.

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This overview is meant as a guide and should not replace assessment and management from a qualified health professional.

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References

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Agosta J, Holzer K (2012) Forefoot Pain in Clinical Sports Medicine 4th Edition p.862-5

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