A stress fracture is a break in a bone that is caused by repetitive stress. It may occur in any bone, but is quite common in the metatarsal bones of the foot. A stress fracture usually starts as a small crack in the outer shell (the cortex) of the bone. Without proper treatment, this may progress to fracture all the way through the bone. If you suspect that you have a stress fracture, call our office right away and tell the receptionist that you think you may have a fracture. The receptionist will try to get you an appointment right away.
Metatarsal stress fractures often appear initially as simply pain over the top of the foot, sometimes – but not always – with swelling. It is usually worse after activity or during activities that require bending of the foot. They are most common in the second and third metatarsal bones. It is very common for patients to state that they have no memory of any injury.
Examination and Treatment
Once we examine your feet, if we feel that you may have a stress fracture we will likely take an x-ray. It should be noted that metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury. Stress fractures of the third and fifth metatarsals seen in the xrays below.
If it turns out that you do likely have a stress fracture, we will immobilize your foot with a special shoe or boot. In addition we will likely use some sort of arch support to help spread weight over a larger portion of the foot. These treatments usually protect your foot so it can heal while allowing you to still bear weight on the foot. Crutches are usually not necessary except for metatarsal base fractures. A Jones fracture is the term used for a fracture approximately 1.5 cm from the base of the 5th metatarsal, Figure 2, these fractures are very difficult to heal and require a long period of non weight bearing or surgery. Bone stimulators are often suggested for a Jone’s fractures.
What Causes Stress Fractures?
- There are a number of causes, but common ones include:
- Decreased density of the bones (e.g.. osteoporosis)
- Unusual stress on a metatarsal due to mal-position or another forefoot deformity (e.g.. bunion)
- Abnormal foot structure or mechanics (e.g.. flatfoot)
- Increased levels of activity, especially without proper conditioning
- Unstable shoes
- Excessive stress (such as running a marathon)
How are Stress Fractures Prevented?
Since stress fractures are usually caused by too much pressure on the metatarsal bone, we want to reduce pressure on that bone to prevent the stress fracture from occurring again. We can do this best with the use of custom orthotics that are prescribed specifically to reduce pressure on the injured portion of the foot. We prescribe the orthotics in a manner that acts to transfer the force off of the at-risk metatarsal and redistribute that force to other parts of the foot. Wearing the proper shoes is also critical and we will help you in finding the correct shoes for your feet.
If you think you may have a stress fracture, or you have previously had one and want to prevent recurrence, contact us for an appointment in our convenient Seattle office.