Special consideration is paid to the fifth metatarsal stress fractures. Neil humble, dpm introduction forefoot pain with the subsequent diagnosis of metatarsal stress fracture is a common clinical situation that arises in the podiatric office. Mt5 stress fracture in football soccer players can be. Proximal base stress fracture of the second metatarsal in. Pain is usually felt over the injured area and tends to develop over a few weeks. Applying axial load to the head of a fractured metatarsal produces pain at the site. In a study of the epidemiology of metatarsal fractures, 68% were found to involve the fifth metatarsal, most commonly resulting from a torsional mechanism. However, if you carry on stressing the bone, the crack will often deepen and widen, becoming gradually more painful. To the best of our knowledge, we report the first documented case of a stress fracture at the proximal base of the second metatarsal in a highland dancer. Diagnosis, treatment, and rehabilitation of stress fractures. Stress fractures less commonly occur in the femur thigh bone, pelvis, spine, and upper extremity. Metatarsal fracture you have a fractured bone in your foot. Nov 17, 2016 a metatarsal fracture is a break to one of the five long metatarsal bones in the foot and is usually caused by a direct impact or trauma. Management and prevention of 5th metatarsal stress fracture.
Metatarsal fractures forefoot anatomy and biomechanics the forefoot serves two major purposes during gait. Metatarsal stress fractures can begin as very small injuries which do not cause severe pain. Im not going to go into the signs and symptoms of a metatarsal stress fracture or stress reaction. A jones fracture can be either a stress fracture a tiny hairline break that occurs over time or an acute sudden break. The symptoms of a stress fracture are pain with running, progressing to pain while standing or walking.
Several anatomic mechanisms are proposed to explain this phenomenon. Metatarsal stress fractures are commonly encountered. Management and prevention of bone stress injuries in long. Sep 17, 2019 stress fractures are most common in the weightbearing bones of the lower leg and foot. Stress fractures occur most often in the second and third metatarsals in the foot, which are thinner and often longer than the adjacent first metatarsal. Tests to confirm the presence of a stress fracture, your doctor. The metatarsal stress fracture is a tiny break or cracks in the bone which occurs due to repetitive overburden in the lower part of the feet. Regardless of the severity of your stress fracture reaction, you will have been told to rest the foot, and minimise loading while the bone settles and heals. In a population study investigating metatarsal fractures, fifth metatarsal fractures occurred most commonly, followed by middle. Point tenderness is often present over the fracture, and axial loading of the meta. This can be an impact such as a direct blowlike forcefully stubbing your toe. The internet is full of that sort of info the meaty and useful information, is what to do once diagnosed. Fifth metatarsal fracture jones fracture rehab protocol. Metatarsal stress fracture rehab guide free download pdf im going to write this article as a guide for rehabilitating the worst case scenario a metatarsal stress fracture enabling a successful return to running.
Avoiding the offending activity, protecting the foot with a boot or protective shoe, and possibly decreasing the patients weightbearing status usually helps the fracture to heal without surgery. Metatarsal stress fractures are microfractures, affecting the second and third metatarsal diaphyses and are a result of constant stress due to the supporting of weight. Presents with pain, swelling on lateral border of foot. Metatarsal fractures musculoskeletal medicine for medical. Stress fractures diagnosis and treatment mayo clinic. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high loadbearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. They typically respond well to cessation of the causative activity for four to eight weeks. Although metatarsal fatigue fractures are more common in athletes, they occasionally occur in a wide variety of individuals secondary to chronic overload or an abrupt increase in everyday activity.
Pdf the diagnosis of stress fractures is based on clinical assessment and on imaging modalities. The first metatarsal is larger than the others and less likely to develop a stress fracture. Stress fracture of the tibial plateau seen on mri in an elderly female walker. Mar 27, 2015 stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. A stress fracture should be suspected in any patient presenting with localized bone or. Metatarsal fractures broken metatarsal symptoms, causes. Three primary types of fractures occur in the proximal fifth metatarsal, and all have different treatment implications. If a fracture is identified in a single metatarsal, the orthopedist must closely inspect adjacent metatarsals and joints, especially the lisfranc articulation. Metatarsal fractures are among the most common injuries of the foot. They are most common in the second and third metatarsal bones. A metatarsal stress fracture can progress to become a fullthickness fracture. Manfreda f, colleluori g, palmieri d, teodori j, rinonapoli g, caraffa a. A stress fracture is a break in the bone that develops after cyclical, submaximal loading.
A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for two weeks, with. It is usually worse after activity or during activities that require bending of the foot. They may involve the bony cortex only, and show up poorly on xray. Stress fractures were first described in military recruits undergoing basic training, as a partial or complete. A fracture in zone 3 is typically a stress fracture caused by overuse and treated underuse. Stress fracture of the 5th metatarsal is the least common fracture type of the proximal 5th metatarsal, with an avulsion fracture being the most common, followed by jones fracture. Most metatarsal fractures will go on to heal uneventfully with appropriate treatment, but complications do occur.
Patients have localized pain, swelling, and inability to bear weight on the lateral aspect of the foot. Stress fractures of the metatarsal shaft usu ally heal well without immobilization, in part because of excellent blood supply. Common stress fractures american family physician aafp. Seeking medical help is key to recovering from this foot injury to ensure the bones heal. Because stress fractures result from repetitive stress, it is important to. Pdf the diagnosis of stress fractures is based on clinical assessment and on imaging. A metatarsal stress fracture is caused by direct trauma or repetitive stress to the foot, such as while jumping, dancing, marching or running. Pdf the pathophysiology, diagnosis, and management of.
Dec 18, 2016 the most frequent fracture seen is the fifth metatarsal, accounting for 68% of metatarsal fractures. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone. Diagnosis and management of metatarsal fractures american. Track and field athletes and military recruits who carry heavy packs over long distances are at highest risk, but anyone can sustain a stress fracture. Suspicion of a stress fracture warrants checking with your doctor. It can take several weeks and sometimes longer than a month for evidence of stress fractures to show on xrays. Stress fractures of the first to fourth metatarsal shafts typically heal well with rest alone and usually do not require. A metatarsal fracture is a crack or break in one of the five metatarsal bones across the top of the foot and ball of the foot. Fifth metatarsal stress fracture in elite male football players. Diagnosis, treatment, and rehabilitation of stress. Because stress fractures result from repetitive stress, it. Stress fracture in foot metatarsal stress fracture. Fractures institute for preventive foothealth ipfh. Risk factors for lower extremity stress fracture injuries have traditionally been cate.
Acute metatarsal fracture fracture corpus ossis metatarsalis figure 4. Injuries to the metatarsal bones are very common and can happen in a number of ways, but most commonly occur when a heavy object falls on them or when they are twisted during a fall. Fifth metatarsal bone fracture types and definition. Although commonly resulting from sporting activity, metatarsal stress fractures are by no means. Diagnosis and management of lisfranc injuries and metatarsal. Stress fracture of the 5 th metatarsal is the least common fracture type of the proximal 5 th metatarsal, with an avulsion fracture being the most common, followed by jones fracture. Improper footwear, a rapid increase in activity, weak muscles, and low bone density can all contribute to the development of a metatarsal stress fracture. There are several types of lowimpact exercises to do while the stress fracture heals. March fractures metatarsal stress fractures were first described in 1855, termed after the foot pain and swelling experienced by prussian. Immediate surgical fixation may be chosen for athletes.
Stress fractures of the lower extremity most commonly involve the tibia and metatarsal bones. When a stress fracture is expected a bone scan may be helpful. Patients usually present with pain, swelling, echymosis and difficulties with walking. Stress fractures are caused by overly stressing the foot when using it in the same way repeatedly.
Care of the young athlete patient education handouts. The metatarsal bones are the long bones in your foot that connect your ankle to your toes. Defined as spontaneous fracture of normal bone which results from the summation of stresses, any of which by themselves would be harmless, 7 most clinicians involved in the care of the foot and ankle will frequently treat these injuries. Stress fractures often cant be seen on regular xrays taken shortly after your pain begins. Tr eatment of metatarsal fractures depends on the type and extent of the fracture, and may include. Overuse of legs and feet for walking, jumping and running overwhelm its natural capacity of bones for selfrepair causing small cracks to develop. Fifth metatarsal fracture jones fracture rehab protocol patient will be walking with crutches nonweightbearing until most of the swelling resolves. The most frequent fracture seen is the fifth metatarsal, accounting for 68% of metatarsal fractures. Morton neuroma may cause pain with compression between the third and fourth metatarsals. Other types of fractures can occur in the fifth metatarsal. Operative results of plantar plating for fifth metatarsal. There are different degrees and types of fractures. Bone stress injuries and stress fractures oxford university hospitals.
Request pdf operative results of plantar plating for fifth metatarsal stress fracture background the treatment of fifth metatarsal stress fractures can be challenging. A stress fracture is a break in the bone that happens with repeated injury or stress. Traumatic fractures also known as acute fractures are caused by the sudden application of force or trauma. Metatarsal stress fractures often appear initially as simply pain over the top of the foot, sometimes but not always with swelling. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high loadbearing activities such as running, military and aerobic exercise and therefore require practitioner. Management and prevention of 5th metatarsal stress. Sep 17, 2019 doctors can sometimes diagnose a stress fracture from a medical history and a physical exam, but imaging tests are often needed. Patient may be in a removable boot after surgery for a week or two at the direction of the physician. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
A metatarsal fracture is a break to one of the five long metatarsal bones in the foot and is usually caused by a direct impact or trauma. Like all other medical issues, not every fracture will fall perfectly into one of these three fracture types, but these categories are useful for treatment guidance. A metatarsal stress fracture usually occurs at one location on one metatarsal bone at any given time. Contributing intrinsic factors such as low bone density, especially in the setting of prior stress fractures or the female athletic triad.
There are five metatarsal bones in each foot, you have fractured the fifth which is on the outer edge of the foot. The truth is a stress fracture develops mostly because of overuse of the bone and can get worse with continued use. Dathan ritzenhein stress fracture 3rd metatarsal goals following stress fracture diagnosis, incorporate deweighting into rehabilitation protocol. Proximal base stress fracture of the second metatarsal in a. March metatarsal stress fracture statpearls ncbi bookshelf. Fractures of the fifth metatarsal foot health facts. Fifth metatarsal fractures avulsion fracture fracture usually extraarticular. This is the area of greatest impact on your foot as you push off when you walk or run. A displaced bone fracture occurs when the broken ends of a fracture move away from one another and a significant gap develops between them. Tenderness is usually localized to the shaft when metatarsal stress fractures occur. Examination should consist of a neurovas cular evaluation and palpation of the foot and ankle. Stress fractures of the foot and ankle in athletes sage journals.
Compared to nonproximal stress fractures, proximal stress fractures of the second metatarsal are particularly uncommon. However, this doesnt mean people have to sit around and do nothing all day. Bone pain from other causes, such as bone cysts, infection, and tumors, must also be ruled out. Rehabilitation and return to running after lower limb stress.
Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Zone one, zone two, and zone three fractures account for 93%, four percent and three percent of proximal fifth metatarsal fractures, respectively. The pain, tenderness, swelling you are experiencing in your foot will settle over a period of several weeks and can take up to several months. They are less common and more difficult to treat than avulsion fractures. Balance and proprioception training neuromuscular training, which involves proprioception, balance, and muscle control, is an essential component of the rehabilitation following musculoskeletal lower limb injury, including stress fracture. This in many cases, if left untreated, is the early stages of a fullon metatarsal stress fracture. Mar 26, 2018 a metatarsal stress fracture can progress to become a fullthickness fracture. Patient will be walking with crutches nonweightbearing until most of the swelling resolves. A disproportionate number of stress fractures occur in the second metatarsal shaft, especially at the neck. Proximal fifth metatarsal fractures are divided into three zones35. Whatever emotions youre dealing with, remember that getting back into running after a stress fracture isnt as easy as lacing up your shoes and heading out the door. Rehabilitation and return to running after lower limb. The treatment of a metatarsal stress fracture is most often nonoperative. Athlete followed physicians recommendations for initial care and treatment.
Jones fractures are caused by overuse, repetitive stress, or trauma. Jones fractures are caused by overuse, repetitive stress or trauma. It could also be a stress fracture which comes on gradually from overuse. Stress fractures are not full thickness breaks although without correct management they may progress to become full thickness breaks. Metatarsal fractures are among the most common injuries of the foot goals of treatment include. Metatarsal stress fracture rehab guide free download pdf im going to write this article as a guide for rehabilitating the worst case scenario a metatarsal stress fracture enabling a. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be. Stress fractures of the foot and ankle orthoinfo aaos. Pdf stress fractures of the foot and ankle researchgate. Bone stress and stress fractures often occur in weightbearing bones, usually in the shin and foot. The first few times out after being cleared to run after a stress fracture can be tough for a few reasons.