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Metatarsal Stress fracture

A very common overuse injury I see in clinic, especially in the spring when everyone is most enthusiastic about their fitness goals, is stress fractures of varying bones. One of these is Metatarsal stress fractures. These were named ‘March Fractures’ many years ago, as new recruit soldiers would often get them during basic training, but they are common on sports persons, both recreational and elite.

Bone stress is a continuum with mild bone marrow oedema (pre stress fracture) at one end, and full fracture at the other. It is caused by an increase in particular activity (or load) faster than the body can adapt to, so ‘too much too soon’. And it is always best to gradually increase your activity to give your body time to recover between sessions. And that fits the profile or the new recruit soldiers, who may have never ‘marched’ before to suddenly marching every day for 8 weeks, ‘too much too soon’

There are other factors that play into this, including:

1. footwear, old or poorly fitting footwear is a known risk factor in runners, and stud placement in football boots is a risk factor.

2. playing surface, commonly seen in football in preseason on hard grass

3. fitness, we know anyone who has completed a marathon previously is at a reduced risk compared to someone competing for the first time.

4. health, vitamin D and K2 deficiencies and low calcium intake are significant risk factors

5. sex, women are 3 times more likely to suffer, and post-menopausal women can be as high as 27x more likely.

6. Biomechanics, running gait can contribute, but a long 2nd Metatarsal or a hypermobile midfoot will also be risk factors.

Signs to look out for are forefoot pain which worsens during sport. Runners will often notice is comes on after the same number of miles each run, gradually shortening as the injury worsens. Pain will build until the sportsperson has to stop (crescendo pain), and pain will often wake the individual from sleep.

When seeking help remember:

1. Xrays miss 67% of stress fractures, MRI is 95% sensitive. Just because A&E did an Xray doesn’t mean you don’t have a stress fracture!

2. Don’t take anti-inflammatories (NSAIDs) these slow bone healing and ive you continue the provocative activity you will make it worse faster.

3. The earlier it is diagnosed the less likely you will be sidelined for as long, and the less likely you will need a fracture boot or worse surgery.

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