Medication Summary

Analgesics may be needed in the acute phase of the treatment for metatarsal stress fractures. The patient often encounters mild to moderate pain until a period of rest and/or immobilization has occurred.

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but these drugs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Advil, Motrin)

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DOC for mild to moderate pain, if there are no contraindications. Ibuprofen inhibits inflammatory reactions and pain by inhibiting the activity of cyclooxygenase, which reduces prostaglandin synthesis.

Ketoprofen (Orudis, Actron, Oruvail)

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For relief of mild to moderate pain and inflammation. Small dosages are indicated initially in patients with small body size, elderly patients, and those with renal or liver disease. Doses >75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.

Naproxen (Aleve, Naprelan, Naprosyn, Anaprox)

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For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

Flurbiprofen (Ansaid)

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May inhibit cyclooxygenase enzyme, which in turn inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.

Class Summary

Pain control is essential for quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

Acetaminophen (Tylenol, Panadol, Paracetamol)

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DOC for pain in patients with documented hypersensitivity to aspirin, NSAIDs, diagnosed with upper GI disease or on oral anticoagulants.

Hydrocodone bitartrate with acetaminophen (Vicodin, Lortab, Lorcet HD)

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Drug combination indicated for moderate to severe pain.

Follow-up

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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 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.

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.

Sections Metatarsal Stress Fracture
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Metatarsal Stress Fracture Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs