Metatarsal Stress Factures

As we stride pass the halfway point of the AFL season, there seems to be an ever mounting injury toll involving the lower limb and foot. Currentlythere are at least 27 foot and ankle injuries listed on the official AFL injury list. This number equates to more than an entire match day squad (including emergency players) being off the park as a result of foot and ankle injuries. Only recently, after 797 days, has the Melbourne Football Club welcomed back Jack Trengrove, a former captain of the club, to the match day team after suffering a two year battle with a stress fracture (and on-going complications) of his navicular bone, located on the inside of the midfoot. Today, however, we will describe a more common stress fracture of the foot that can occur in not only footballers, but everyone from track and field athletes to tennis players and basketballers, all the way to the non-athletic day to day population engaging in recreational sports; the metatarsal stress fracture.

What is a metatarsal stress fracture?

Firstly, a metatarsal bone is an important bone in the structure of the foot which resides in the forefoot. It is the bone that connects the midfoot joints to each of the five toes. Therefore there are 5 metatarsal bones per foot, and 10 in total for both feet. A metatarsal stress fracture is best described as a small crack within one of the 5 metatarsal bones of the forefoot.

What causes metatarsal stress fractures?

Metatarsal stress fractures are a common mechanical overload injury, occurring as a result of consistent and repetitive strain on the bone. It is thought that up to 35% of foot stress fractures are accounted to the metatarsal bones. They occur frequently in the 2nd and 3rd metatarsal bones.

They are also often a result of increasing your level of activity (be it amount or intensity) of an activity too quickly. Additionally, they may be caused by the impact of a new or unfamiliar training surface (e.g. tennis – soft clay court to a hard court), footwear (poor, old or worn out) that no longer provides enough support and an increased workload (e.g. an athlete or footballer with a sudden large increase in playing time).

Note that metatarsal stress fractures differ from acute metatarsal fractures in that acute fractures are cause by a single event (trauma or maximal load – e.g. suffering a fall or dropping something on your foot) rather than a repetitive loading of the bone (rapidly increasing running distance or going from 1-2 games to 3-4 games of basketball/tennis/training) per week.

Signs and Symptoms

Signs and symptoms that you should be on the lookout for if you suspect you or someone you know may have a metatarsal stress fracture in their foot include:

• Pain in the forefoot area that increases as you continue and stops when you cease your activity. Stress fractures do not ‘warm up’ during activity, unlike common conditions such as plantar fasciitis or tendinopathies.
• Swelling on the top of the foot.
• Pain at night while lying in bed.
• Greater pain in shoes with a higher heel as opposed to a shoe with a lower or flat heel.

Treatment

Treatment may differ from case to case, dependant largely on activity amount and frequency, the training goals of the individual and level of professionalism regarding the injury – a distance runner athlete’s treatment may differ from someone playing recreational weekend soccer. Imaging such as X-ray or MRI can be useful in diagnosis and treatment.

Treatment direction may include the following:

• A period of rest from all weight baring exercise (will include modifying training if resting is difficult – especially for elite athletes)
• Appropriate footwear.
• Orthotic treatment – some cases will differ and may not require orthotics.
• Immobilisation with removable CAM walkers (moonboot) – again, some cases will differ and may not require this step.
• Modification and proper planning of training + workload when re-entering into activity.

If you suspect you may have a metatarsal stress fracture, it is best to have it assessed sooner rather than later by one our qualified Melbourne Podiatrists in order to develop a management plan and rehabilitation program. Early therapy can decrease pain and rehabilitation time earlier rather than delaying and potentially complicating the problem further. We also stock a range of CAM boots that can be purchased or hired to help treat and immobilise stress fractures and other foot fractures without the need for crutches.