Metatarsal Stress Fracture Follow-up

Updated: Jan 16, 2019
  • Author: Valerie E Cothran, MD; Chief Editor: Craig C Young, MD  more...
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Follow-up

Return to Play

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  • 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.

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Complications

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  • 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.

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Prevention

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  • 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.

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Prognosis

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  • 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%.

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Patient Education

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  • 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.

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