metatarsal stress fracture

• related: MSK
• tags: #msk

Cause

• Repetitive activities (eg, running, gymnastics, military recruits).
• Abrupt increase in physical activity. Inadequate calcium & vitamin D intake
• Decreased caloric intake.
• Female athlete triad: low caloric intake, hypomenorrhea/amenorrhea, low bone density

Symptoms

Insidious onset of localized pain. Point tenderness at fracture site.

Diagnosis

Examination shows focal point tenderness near the metatarsal shaft. Possible negative x-ray in the first 6 weeks but may reveal periosteal reaction at the site of the fracture.

Treatment

• Reduced weight bearing for 4-6 weeks and simple analgesics (acetaminophen).
• Do not use NSAIDS as it can delay healing.
• Referral to orthopedic surgeon for fracture at high risk for malunion (eg, anterior tibial cortex, 5th metatarsal).
• Pts with continued pain can be given wide, hard-sole podiatric shoe.

Stress fractures of the fifth metatarsal shaft are at increased risk for nonunion and are usually managed with casting or internal fixation. However, stress fractures of the middle (ie, second, third, and fourth) metatarsals usually heal well and do not require casting or surgery unless there is severe pain, displacement, or other complicating factors.