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Metatarsal Stress Fracture

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Metatarsal Stress Fracture, March Fracture

  • See Also
  1. Metatarsal Fracture
  2. Proximal Fifth Metatarsal Fracture
  3. Foot Fracture
  • Epidemiology
  1. Second and Third Metatarsals most commonly involved
    1. Military recruits (March Fracture)
    2. Ballet Dancers (associated with dance on toe tips)
    3. Sanderlin (2003) Am Fam Physician 68:1527-32 [PubMed]
  2. Fifth Metatarsal Stress Fractures are least common
    1. Associated with Genu Varum
    2. Differentiate from Jones Fracture
    3. Increased risk of nonunion
    4. Harmath (2001) Orthopedics 24:111 [PubMed]
  • Symptoms
  1. Localized pain at Fracture site
    1. Initially pain onset only with activity
  • Signs
  1. Metatarsal Head Axial loading test positive (see Metatarsal Fracture)
  2. Point tenderness over Fracture site
  • Imaging
  1. XRay
    1. Fracture line usually not present for 2-6 weeks from onset of Fracture
  2. MRI or Bone Scan are more sensitive
    1. Not necessary if Stress Fracture treated empirically based on clinical findings
  • Management
  1. Type 1: Acute Fracture without XRay changes
    1. Often heals well without immobilization
    2. Option 1
      1. Avoid offending activity for 4-8 weeks
    3. Option 2 (if painful ambulation despite Option 1)
      1. Crutch walking with partial weight bearing for 1-3 weeks
    4. Option 3 (if severe pain despite Option 2)
      1. Immobilize with short-leg cast and non-weight bearing for 1-3 weeks
  2. Type 2: Delayed union with wide Fracture line
  3. Type 3: Recurrent symptoms and established non-union
    1. Manage surgically with internal fixation
  • Prevention
  1. See Stress Fracture
  2. Gradually return to prior activity
  3. Custom Orthotic may be considered in some cases (e.g. long second Metatarsal)
  • Course
  1. Variable healing by conservative methods in 8-70 weeks
  • Complications
  • Non-union Fracture or Avascular Necrosis
  1. Proximal Fifth Metatarsal Fracture is highest risk
  2. Second Metatarsal Head AVN (Freiberg's Infarction)
    1. Seen in adolescents
  • References
  1. Hatch (2007) Am Fam Physician 76:817-26 [PubMed]