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.

Complications

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.

Prevention

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.

Prognosis

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.

Questions

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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.