MANUAL MINORS
A metatarsal stress fracture is an overuse injury that occurs when repetitive forces applied to the foot exceed the bone’s ability to repair itself. It is common among runners, dancers, and military personnel, often affecting the 2nd and 3rd metatarsals. This condition develops gradually and presents with localised pain in the midfoot, which worsens with physical activity.
Diagnosis
Diagnosis is based on a clinical history of progressively worsening pain during physical activity and physical examination, revealing tenderness on palpation over the affected metatarsal. Initial X-rays may appear normal, but after 2-3 weeks, they can show signs of a fracture. In early cases, MRI or bone scans are helpful in detecting injuries.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Acute metatarsal fracture | Occurs after direct trauma or twisting, with sudden onset of pain. |
Jones fracture | Fracture at the base of the 5th metatarsal, with poor healing potential. |
Plantar fasciitis | Pain in the heel or sole, not over the metatarsals. |
Tendinitis | Localised pain in the foot tendons, with no radiographic evidence of fracture. |
Emergency Management
In the emergency department, it is essential to advise the patient to avoid weight-bearing on the affected foot and recommend crutches or an immobilisation boot. Analgesia with NSAIDs or pain relievers should be provided. The patient should be referred to an orthopaedic specialist or sports medicine physician for further evaluation and follow-up.
Definitive Treatment
Conservative treatment is the standard approach, involving rest from impact activities for 6-8 weeks. It is crucial to avoid the activities that caused the injury until symptoms fully resolve. In some cases, physiotherapy is helpful for strengthening foot muscles and improving biomechanics. If healing is delayed or the fracture is complex, surgical intervention may be considered.
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