eMedicine Specialties > Sports Medicine > Foot and Ankle

Metatarsal Stress Fracture: Follow-up

Author: Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Contributor Information and Disclosures

Updated: Aug 12, 2009

Follow-up

Return to Play

  • 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.

Complications

  • 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.

Prevention

  • 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.

Prognosis

  • 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%.

Education

  • 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 eMedicine's Breaks, Fractures, and Dislocations Center and Sports Injury Center. Also, see eMedicine's patient education article Broken Foot.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis of metatarsal stress fracture
  • Failure to pursue the diagnosis if plain films are negative
  • Failure to refer patients with fifth-metatarsal stress fractures to an orthopedic specialist
 


More on Metatarsal Stress Fracture

Overview: Metatarsal Stress Fracture
Differential Diagnoses & Workup: Metatarsal Stress Fracture
Treatment & Medication: Metatarsal Stress Fracture
Follow-up: Metatarsal Stress Fracture
Multimedia: Metatarsal Stress Fracture
References
Further Reading
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References

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Further Reading

Gehrmann RM, Renard RL. Current concepts review: stress fractures of the foot. Foot Ankle Int. Sep 2006;27(9):750-7. [Medline].

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Keywords

metatarsal stress fracture, march fracture, stress fracture of the metatarsals, foot fracture, foot stress fracture, broken foot, fractured foot, female athlete triad Breithaupt fracture

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Contributor Information and Disclosures

Author

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.

Medical Editor

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, 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
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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