History

See the list below:

Patients usually report having increased the intensity or duration of their exercise regimen.
Initially, dull pain only occurs with exercise, then the condition progresses to pain at rest.
Pain starts diffusely, then localizes to the site of the fracture.
Stress fractures can be historically distinguished from a true Jones fracture, because patients with a stress mechanism as the etiology report a long history of prodromal symptoms of pain over the proximal fifth metatarsal.
Menstrual irregularities should be explored in female patients due to a high association between female athletics, amenorrhea, and osteoporosis — otherwise known as the female athletic triad.^{[13, 14]}

Physical

See the list below:

Inspect the affected foot for swelling, bruising, or warmth.
Inspect both feet for a side-by-side comparison.
Palpate the affected foot to find the point of maximal tenderness. Specifically seek to determine if the point of maximal tenderness is related to bony or soft-tissue problems.
Inspect the patient's athletic shoes for signs of excessive supination or excessive wear under the metatarsal heads.

Causes

See the list below:

Increased intensity, duration, or frequency of exercise
New footwear
Insufficient rest periods
Continuing to train despite pain
Osteopenia/osteoporosis
Rheumatoid arthritis
Neuropathic foot
Female athletic triad

Differential Diagnoses

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Media Gallery

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.

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Author

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

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.

Acknowledgements

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.