Stress Fracture of the Metatarsal Bone
You have just been diagnosed with a stress fracture in your foot? You just can not possibly wrap your head around how this happened to you. You did not fall and no one hit your foot, so why is this happening to you?
We see metatarsal stress fractures in the office on a daily basis. Some patients are distance runners who strike the foot more on the ball when they run and some patients just wake up one morning after no activity and notice their one foot is red, hot and swollen.
What is a metatarsal stress fracture
A metatarsal stress fracture is a fracture in the bone that usually is a gradual, for lack of a better way to explain it, crack on a part of the bone. With continued weight bearing the bone continues to get "Stressed." I often explain it to patients like this, if you take a twig and bend it, it will splinter a little and as soon as you stop bending the twig the splinters are no longer visible. Repeated bending or in the case of the bone, loading to foot with pressure by just walking and running, the splintering can get worse and eventually break all the way through.
Early diagnosis is the key
If you have a sharp pain on the top of the foot it could be a lot of things, with 28 bones in the foot you can not just jump to a metatarsal fracture diagnosis. I tell patients this is really a clinical diagnosis at first. If you are having this pain and see the doctor they will take an X-ray. Believe it or not, most people have no X-ray changes on that first film,( remember the twig.) But the doctor should palpate the foot and each metatarsal bone. Typically, with a metatarsal stress fracture, when the doctor pushes on the effected bone the patient will jump and say there is pain. The doctor will start the treatment plan and will have the patient follow up in one month to re-X-ray. It is typical to then see what we call bone callus from the healing fracture. In elite athletes, we may get an MRI but in most cases this is not necessary .
Treatment
For most people the treatment is a short cam walking boot. (I added a link to Amazon below) I tell the patient they may be able to get out of the boot in 4 weeks but sometimes the patient is stuck in the boot for 8 plus weeks. Most of this truly depends on how good the patient is at wearing the boot anytime they put weight on their foot.
Most people screw up and take the boot off at home, which puts some stress on the foot. I always say, wear the boot anytime the foot touches the ground. The more you protect the bone the better your outcome will be!
This patient had no X-ray changes on first visit, but after a couple months you can clearly see where the bone was fractured on the fourth metatarsal bone.
Beware of the Neuroma Diagnosis
Here I just share a cautionary tale of the quick diagnosis of a neuroma, when indeed the foot is broken.
If you are having pain and swelling in the foot, it is most likely not a neuroma. The doctor should be palpating each metatarsal bone and really evaluating what is happening. Again, on the fist visit there may be no changes on X-ray.
If you are having foot pain, come see us at The Center for Ankle and Foot Care. You can schedule online here!