Medscape is available in 5 Language Editions – Choose your Edition here.


Metatarsal Stress Fracture Follow-up

  • Author: Valerie E Cothran, MD; Chief Editor: Craig C Young, MD  more...
Updated: Dec 30, 2015

Return to Play

See the list below:

  • After recovery from metatarsal stress fractures, patients may return to play when they can participate without pain.
  • The intensity and duration of activities need to be increased slowly, and the patient must adhere to regular rest periods.


See the list below:

  • Nonunion is the primary complication of metatarsal stress fractures.
  • Nonunion rates of 35-50% in fifth-metatarsal stress fractures are reported in the literature. For other metatarsal stress fractures, the nonunion rate is low.


See the list below:

  • Increases in sports-training demands, whether in intensity or duration, should be performed in a slow cyclical manner, and rest periods need to be built into training regimens. Use of orthotics has not been proven to decrease the incidence of metatarsal stress fractures.
  • Athletes who develop pain during exercise need to decrease their training level to one that is painless, and then they can slowly resume a training regimen.
  • Physicians, coaches, trainers, and parents need to be aware of metatarsal stress fractures and the symptoms. Prompt treatment can reduce morbidity and time lost from the offending sport or activity.


See the list below:

  • Stress fractures in the first 4 metatarsals routinely heal without complication.
  • Stress fractures at the base of the fifth metatarsal have a nonunion rate of 35-50%.

Patient Education

See the list below:

  • The key to preventing stress fractures lies in the education of athletes, parents, coaches, trainers, and doctors.
  • Properly selected and fitted equipment, particularly running shoes, is important in deterrence of metatarsal stress fractures.
  • Training needs to be performed in a slow cyclical progression that allows the body to adapt. Adequate rest and recovery time needs to be incorporated into the participant's training regimen.
  • The quality of physical activity, rather than quantity, should be stressed in any exercise program.
  • The athlete, coach, trainer, and physician must recognize that exercise regimens are not "one size fits all." Tailor the training to the participant's baseline ability, previous experience, and current level of physical activity.

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education article Broken Foot.

Contributor Information and Disclosures

Valerie E Cothran, MD Assistant Professor, Department of Family and Community Medicine, Director of Primary Care Sports Medicine Fellowship, University of Maryland School of Medicine; Assistant Team Physician, University of Maryland

Valerie E Cothran, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.


Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Maitra RS, Johnson DL. Stress fractures. Clinical history and physical examination. Clin Sports Med. 1997 Apr. 16(2):259-74. [Medline].

  2. Ekstrand J, van Dijk CN. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. Br J Sports Med. 2013 Apr 9. [Medline].

  3. Rongstad KM, Tueting J, Rongstad M, Garrels K, Meis R. Fourth Metatarsal Base Stress Fractures in Athletes: A Case Series. Foot Ankle Int. 2013 Feb 5. [Medline].

  4. Hockenbury RT. Forefoot problems in athletes. Med Sci Sports Exerc. 1999 Jul. 31(7 suppl):S448-58. [Medline].

  5. Finestone A, Milgrom C, Wolf O, Petrov K, Evans R, Moran D. Epidemiology of metatarsal stress fractures versus tibial and femoral stress fractures during elite training. Foot Ankle Int. 2011 Jan. 32(1):16-20. [Medline].

  6. Balius R, Pedret C, Estruch A, Hernández G, Ruiz-Cotorro A, Mota J. Stress fractures of the metacarpal bones in adolescent tennis players: a case series. Am J Sports Med. 2010 Jun. 38(6):1215-20. [Medline].

  7. Hetsroni I, Nyska M, Ben-Sira D, Mann G, Segal O, Maoz G, et al. Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture. Foot Ankle Int. 2010 Mar. 31(3):203-11. [Medline].

  8. Polzer H, Polzer S, Mutschler W, Prall WC. Acute fractures to the proximal fifth metatarsal bone: development of classification and treatment recommendations based on the current evidence. Injury. 2012 Oct. 43(10):1626-32. [Medline].

  9. Queen RM, Mall NA, Nunley JA, Chuckpaiwong B. Differences in plantar loading between flat and normal feet during different athletic tasks. Gait Posture. 2009 Jun. 29(4):582-6. [Medline].

  10. Fujitaka K, Taniguchi A, Isomoto S, Kumai T, Otuki S, Okubo M, et al. Pathogenesis of Fifth Metatarsal Fractures in College Soccer Players. Orthop J Sports Med. 2015 Sep. 3 (9):2325967115603654. [Medline].

  11. Reeder MT, Dick BH, Atkins JK, Pribis AB, Martinez JM. Stress fractures. Current concepts of diagnosis and treatment. Sports Med. 1996 Sep. 22(3):198-212. [Medline].

  12. Brukner P, Bennell K. Stress fractures in female athletes. Diagnosis, management and rehabilitation. Sports Med. 1997 Dec. 24(6):419-29. [Medline].

  13. Sallis RE, Jones K. Stress fractures in athletes. How to spot this underdiagnosed injury. Postgrad Med. 1991 May 1. 89(6):185-8, 191-2. [Medline].

  14. Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987 Jan-Feb. 15(1):46-58. [Medline].

  15. Monteleone GP Jr. Stress fractures in the athlete. Orthop Clin North Am. 1995 Jul. 26(3):423-32. [Medline].

  16. Deutsch AL, Coel MN, Mink JH. Imaging of stress injuries to bone. Radiography, scintigraphy, and MR imaging. Clin Sports Med. 1997 Apr. 16(2):275-90. [Medline].

  17. Kiuru MJ, Pihlajamaki HK, Hietanen HJ, Ahovuo JA. MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity. Acta Radiol. 2002 Mar. 43(2):207-12. [Medline].

  18. Spitz DJ, Newberg AH. Imaging of stress fractures in the athlete. Radiol Clin North Am. 2002 Mar. 40(2):313-31. [Medline].

  19. Banal F, Gandjbakhch F, Foltz V, et al. Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients. J Rheumatol. 2009 Jun 30. epub ahead of print. [Medline].

  20. Weinfeld SB, Haddad SL, Myerson MS. Metatarsal stress fractures. Clin Sports Med. 1997 Apr. 16(2):319-38. [Medline].

  21. Tsukada S, Ikeda H, Seki Y, Shimaya M, Hoshino A, Niga S. Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series. Sports Med Arthrosc Rehabil Ther Technol. 2012 Jul 20. 4(1):25. [Medline]. [Full Text].

  22. Albisetti W, Perugia D, De Bartolomeo O, et al. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers. Int Orthop. 2009 May 5. epub ahead of print. [Medline].

  23. Smith JT, Halim K, Palms DA, Okike K, Bluman EM, Chiodo CP. Prevalence of vitamin D deficiency in patients with foot and ankle injuries. Foot Ankle Int. 2014 Jan. 35(1):8-13. [Medline].

  24. Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med. 1997 Apr. 16(2):179-96. [Medline].

  25. Brukner P, Bradshaw C, Bennell K. Managing common stress fractures: let risk level guide management. Phys Sports Med. 1998. 26(8):39-47.

  26. Burr DB. Bone, exercise, and stress fractures. Exerc Sport Sci Rev. 1997. 25:171-94. [Medline].

  27. Chen RC, Shia DS, Kamath GV, Thomas AB, Wright RW. Troublesome stress fractures of the foot and ankle. Sports Med Arthrosc. 2006 Dec. 14(4):246-51. [Medline].

  28. Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA. Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med. 2007 Aug. 41(8):510-4. [Medline].

  29. Coady CM, Micheli LJ. Stress fractures in the pediatric athlete. Clin Sports Med. 1997 Apr. 16(2):225-38. [Medline].

  30. Fredericson M, Jennings F, Beaulieu C, Matheson GO. Stress fractures in athletes. Top Magn Reson Imaging. 2006 Oct. 17(5):309-25. [Medline].

  31. Guettler JH, Ruskan GJ, Bytomski JR, et al. Fifth metatarsal stress fractures in elite basketball players: evaluation of forces acting on the fifth metatarsal. Am J Orthop. 2006 Nov. 35(11):532-6. [Medline].

  32. Heaslet MW, Kanda-Mehtani SL. Return-to-activity levels in 96 athletes with stress fractures of the foot, ankle, and leg: a retrospective analysis. J Am Podiatr Med Assoc. 2007 Jan-Feb. 97(1):81-4. [Medline].

  33. Knapp TP, Garrett WE Jr. Stress fractures: general concepts. Clin Sports Med. 1997 Apr. 16(2):339-56. [Medline].

  34. Nagel A, Fernholz F, Kibele C, Rosenbaum D. Long distance running increases plantar pressures beneath the metatarsal heads: a barefoot walking investigation of 200 marathon runners. Gait Posture. 2007 Feb 2. epub ahead of print. [Medline].

  35. Queen RM, Crowder TT, Johnson H, Ozumba D, Toth AP. Treatment of metatarsal stress fractures: case reports. Foot Ankle Int. 2007 Apr. 28(4):506-10. [Medline].

  36. Quill GE Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am. 1995 Apr. 26(2):353-61. [Medline].

  37. Sammarco GJ. The Jones fracture. Instr Course Lect. 1993. 42:201-5. [Medline].

  38. Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984 Feb. 66(2):209-14. [Medline]. [Full Text].

  39. Ferguson KB, McGlynn J, Jenkins P, Madeley NJ, Kumar CS, Rymaszewski L. Fifth metatarsal fractures - Is routine follow-up necessary?. Injury. 2015 Aug. 46 (8):1664-8. [Medline].

  40. Weel H, Mallee WH, van Dijk CN, Blankevoort L, Goedegebuure S, Goslings JC, et al. The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial. BMC Musculoskelet Disord. 2015 Aug 20. 16:211. [Medline].

Radiograph of the feet. This image depicts a stress fracture of the left second metatarsal with exuberant callus.
Radiograph of the left foot. This image depicts a stress fracture of the fifth metatarsal.
Bone scan of the lower extremities. This image depicts a right fifth metatarsal stress fracture.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.