Metatarsal stress fracture(march fracture)

Findings

The history is generally of a gradual onset of pain with activities, although the onset can be acute. The pain is worse on impact, better with rest. There is usually puffy swelling of the forefoot, with local tenderness to palpation over the metatarsal shaft on both dorsal and plantar surfaces. A metatarsalgia and interdigital neuritis may accompany this problem.

Cause

A stress fracture is produced in the shaft of the second, third or fourth metatarsal from too rapid incremental loads. Often can be seen in army recruits about 3-4 weeks into training, with marching.

Treatment

Rest from impact for 6-8 weeks, but cross-train by exercise such as swimming, biking or rowing to maintain fitness. Use firm shoes or a cast boot to act as a splint, and use the Achilles ladder on return to activity.

Sports

Usually occurs from running, but can occur with walking, marching and change of direction sports.

The puffy swelling on the dorsum of the foot and localized tenderness, especially if present on both dorsal and plantar surfaces, are almost pathognomonic. Repeat X-rays will monitor healing callus but pain is the best guide as to when to return to activities.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English