Ace Physiotherapy and Sports in Singapore
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ACE PHYSIO SPORTS
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Stress Fracture of the Metatarsal
What is a metatarsal stress fracture?
The metatarsals are the long bones located in the forefoot. A metatarsal stress fracture is a small crack or incomplete fracture in one of these bones. The most common site is the neck of the second metatarsal, as this bone is typically the longest and thinnest, making it more susceptible to stress. However, stress fractures can develop in any of the five metatarsal bones in either foot. Physiotherapy plays an important role in treating and rehabilitating metatarsal stress fractures.
How does a metatarsal stress fracture happen?
Metatarsal stress fractures are usually caused by a combination of factors. Poor or unstable foot mechanics, along with repetitive loading of the forefoot during activities such as running or jumping, place continuous stress on the metatarsal bones. Wearing tight footwear or high heels can further increase the strain on these bones and contribute to the development of a stress fracture.
Stress fractures of the metatarsals occur due to an imbalance between bone formation and bone resorption. When a metatarsal is repeatedly loaded during weight-bearing exercise, it increases its bone turnover in order to adapt. This is a normal response that allows the bone to withstand the mechanical demands placed on it.
If repeated stress is applied to a metatarsal, small areas of the bone can become damaged. These damaged areas are then resorbed and replaced with new bone. However, if new bone formation is slower than the removal of old bone, weak spots begin to form in the metatarsal. If this weak area continues to be overloaded, it may eventually develop into a stress fracture.
A recent change in training habits is often a contributing factor in the development of a metatarsal stress fracture. This may involve an increase in training frequency, duration, or intensity, or a change in training surface or footwear.
What are the symptoms of a metatarsal stress fracture?
Metatarsal stress fractures typically cause pain on the top of the foot. The area is often red and swollen, and the pain becomes worse with exercise or prolonged activity. Squeezing the forefoot or pressing down on the top of the foot can also increase the pain. Other symptoms may include:
- Pain that improves with rest but returns during activity
- Tenderness when touching a specific spot on the metatarsal
- Difficulty bearing weight on the affected foot
- A dull ache that may progress to sharp pain if untreated
- Pain when walking barefoot or wearing hard-soled shoes
- Feeling like there's a bruise or stone under the foot (in some cases)
What should I do if I have a metatarsal stress fracture?
If you have, or suspect you have, a metatarsal stress fracture, you should stop any activity on the affected foot immediately. You should arrange a physiotherapy appointment, or visit your nearest accident and emergency department, to get an accurate diagnosis. In the meantime, you can follow the RICE protocol (Rest, Ice, Compression, Elevation) to help reduce pain and swelling.
What shouldn’t I do if I have a metatarsal stress fracture?
If you suspect a metatarsal stress fracture, you should stop exercising immediately. You should also avoid wearing tight footwear or high-heeled shoes, as they may worsen the condition.
Physiotherapy treatment for a metatarsal stress fracture.
Your physiotherapist can diagnose, treat, and help prevent future metatarsal stress fractures. Treatment may include dietary guidance, footwear modifications, orthotic support, and tailored training advice. Imaging techniques, such as CT or MRI scans, may be used to confirm the diagnosis and guide the development of an appropriate treatment plan.
Surgery may be considered for metatarsal stress fractures that fail to heal with conservative treatment. After surgery, your physiotherapist will design a rehabilitation programme to help you return to activity and sport as safely and efficiently as possible. Other physiotherapy options include:
- Gradual return-to-weight-bearing guidance to ensure safe loading of the foot
- Strengthening exercises for the foot, ankle, and lower leg muscles
- Stretching exercises to maintain flexibility and reduce mechanical stress
- Balance and proprioception training to improve control and prevent re-injury
- Manual therapy or joint mobilisation to address stiffness or soft tissue tightness
- Low-impact cross-training (e.g., swimming, cycling) to maintain fitness during recovery
- Gait and movement analysis to correct poor mechanics that contributed to the injury
- Education on load management and programming to avoid overtraining in the future
Could there be any long-term effects from a metatarsal stress fracture?
Proper management of metatarsal stress fractures is essential to prevent long-term complications, such as non-healing or necrosis (bone death). Surgery may be required for fractures that fail to heal fully. Stress fractures involving the base of the second metatarsal carry a higher risk of complications, so early and accurate diagnosis of all stress fractures is crucial.
To arrange an appointment, please call +65 81535374 or visit acephysiosports.com.
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