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Metatarsal Stress Fractures: How Chronic Forefoot Pain can be More Than you Think

Have you ever had a nagging pain the ball of the foot that doesn’t seem to go away. You feel it if yIu run and it gets better if you stop physical exercises for a couple of weeks. You may even notice some swelling in the area. Pain in the forefoot can have many causes from metatarsalgia to Morton’s neuroma to the dreaded stress fracture.

What is a Metatarsal Stress Fracture?

The metatarsal bones are a group of five long bones in the forefoot located between the tarsal bones (midfoot) and the toes. A metatarsal stress fracture or a march fracture can be caused by sudden impact or by repetitive microtrauma such as casual walking. A stress fracture progresses over the  period of many days, weeks or months.  It is characterized by swelling and pain which  are exacerbated with further activity and improve with rest. The initial onset of pain and swelling is gradual and hardly noticeable. Strenuous physical activity or high impact exercises can lead to worsening of both the swelling and the pain.

Who is Susceptible to Stress Fractures? 

In athletes, particularly runners, prolonged and repetitive exercise can cause enough stress for the bone to crack. Poor foot biomechanics can lead to overload of the forefoot leading to metatarsal stress fractures. Not limited to runners, this type of foot fractures can occur in gymnasts and ballet dancers. Furthermore, athletes engaged in high impact aerobics are more susceptible to metatarsal stress fractures.

Causes: 

The fracture is most commonly found in third and fourth metatarsal bones and can affect the second metatarsal if the second toe is longer than the first. Poor architecture of the foot leads to decrease in shock absorption at the forefoot causing the metatarsal bones to crack. Even feet with no biomechanical abnormalities can have a metatarsal stress fracture. Overuse such as running on hard surfaces in improper shoes or use of high heels for long periods of time can cause a stress fracture.
  • Overuse
  • Overpronation
  • Oversupintaion
  • Certain diseases that adversely affect bones and joints.

 

Consult With Podiatrist for Further Assessment and Treatment:

A brief history and physical examination is the first step. If there is a high index of suspension, an x-Ray and possibly MRI are performed. Metatarsal stress fractures can be difficult to detect on X- rays particularly in the first 2-3 weeks. As a result, MRI scan or ultrasound would be required to confirm the diagnosis and to rule out other causes of forefoot pain such as Morton’s neuroma, metatarsalgia or bursitis.

Dr Sami is an expert podiatrist in Dubai-UAE, interested in overuse injuries related to sports.

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