Metatarsil stress fracture

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Pain experienced on the outer aspect of the foot when walking or standing can be attributed to that of a fifth metatarsal stress fracture. We have 5 metatarsal bones in our foot and a stress fracture is a small crack that occurs in the head of the metatarsal bone due to overuse of the foot when walking or running. Invariably factors such as overtraining with an injury, walking on poor surfaces or poor footwear and bone density are the cause of injury. A stress fracture can also occur in the 2nd and 3rd metatarsal bone can cause pain into the front of the foot when weight bearing.

Pain experienced on the outer aspect of the foot when walking or standing can be attributed to that of a fifth metatarsal stress fracture. We have 5 metatarsal bones in our foot and a stress fracture is a small crack that occurs in the head of the metatarsal bone due to overuse of the foot when walking or running. Invariably factors such as overtraining with an injury, walking on poor surfaces or poor footwear and bone density are the cause of injury. A stress fracture can also occur in the 2nd and 3rd metatarsal bone can cause pain into the front of the foot when weight bearing.

Signs and symptoms

Patient reports sharp severe pain on the outside border of the foot during weight bearing activities

Pain is aggravated on walking standing and relieved with rest

Swelling is noted on the outside of the ankle joint

Some bruising may be present

Examination of the walking / running shoe can show increased wear on the 5th metatarsal area

Stress fracture causes:

Poor technique – a runner or walker may alter the weight bearing stance of the foot due to the presence of a blister or tendinitis issue such as plantar fasciitis. 
This may force them to exert too much pressure on the outside of the foot, thus stress the head of the 5th metatarsal bone.

Sudden Switching from grass surface to road surface with the same running or walking intensity can place too much sudden pressure on the outside foot area because it has not been adequately conditioned for the harder road surface.

Wearing tight narrow running shoes that are unsuitable for someone who has flat feet.

Osteoporosis – a lack of density in the bones increase the risk of stress fracture.

Treatment and management

Diagnosis of metatarsal stress fractures is confirmed through X-ray. Ceasing weight bearing activity is vitally important with the foot being immobilised through the use of crutches for a period 6-8 weeks. Where there is a more severe fracture of the fifth metatarsal a custom boot or cast with crutches, which will serve to keep the bones in a fixed position, will have to be worn for approximately 6-8 week period. Prescribed rehabilitation exercises from your physical therapist (MIAPT) are then required in order to resume activity.

Tomás Ryan is is based in Clonmel & Thurles. Contact No: 0504 26672 or email: info@tipp-phyiscaltherapy.ie