Metatarsal Stress Fractures

Progression of Stress Fracture

METATARSAL STRESS FRACTURES
By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S.
 

Stress fractures are relatively common to the metatarsal bones.  They occur when a patient’s activity level over a short period of time has been drastically increased.  This can occur in a patient that starts a training season for track or any type of running sport.  It can also be seen in military recruits when they start their training season.  Stress fractures of metatarsals are also common in women who change their job and all of a sudden have to wear a high-heeled shoe consistently.  This puts stress on the metatarsals and causes a small fracture. 

Stress fractures are often a clinical diagnosis as x-rays may be negative initially.  The patient would typically experience pain and swelling across the top of the metatarsals.  Pain would be mild in the morning.  However, would get worse with weightbearing.  When x-rays are negative these problems are still treated as a fracture.  X-rays taken 14-21 days after the injury will often show healing of the stress fracture by bone callus along the shaft of the bone.

Stress fractures that occur towards the end of the bone in the metaphysial region often go nondisplaced after the healing process.  Stress fractures that occur in the midportion of the metatarsal can displace up, causing the potential for future problems in the metatarsal head region. 

Diaphysial stress fractures of the fifth metatarsal are more uncommon.  These fractures are in an area of the fifth metatarsal bone that has a very poor blood supply.  These fractures are often treated with eight weeks nonweightbearing.  In rare cases the fracture does not heal and it may require a small screw to be placed through the bone to allow the fracture to heal.  In athletes that do a lot of running or those who have a foot that has a slight turning in of the front part relative to the back part of the foot, surgery may be indicated earlier due to the high propensity for refracture following healing of the primary fracture.

Stress fractures of the metatarsal are also more frequent in some patients that have long metatarsals.  Treatment for these stress fractures are often just the use of a boot to unload the metatarsal during the healing process.  This would be followed by an orthotic to be placed in the shoe to rebalance the weightbearing distribution of the metatarsal heads.  Long-term prognosis is usually excellent.  Rarely do stress fractures fail to heal.  Rarely is surgery necessary for these injuries.   


Series of Fifth Metatarsal Stress Fractures

Preop and Postop Jones Fracture

This patient neglected her fracture for 2 months before seeing a doctor. She walked in a boot for a couple months but did not heal

Percutaneous Screw fixation and 16 weeks later she is healed and pain free

Jones Fracture Pre and Postop

Jones Fracture Preop and Postop

 

Jones Fracture Status Post Percutaneous Screw Fixation 8 weeks postop

Preop and 12 Wks Postop Jones Fracture

Jones Fracture Preop

Jones Fracture Status Post Percutaneous Screw Fixation 10 weeks postop

Stress Fracture of 5th Metatarsal (Jones Fracture)

 

Preop and Postop Jones Fracture Fixation

Diaphyseal stress fracture before and after percutaneous screw fixation

 

Metaphyseal-Diaphyseal 5th Metatarsal Stress Fracture

Metaphyseal-Diaphyseal 5th Metatarsal Stress Fracture S/P Percutaneous Screw Fixation

Diaphyseal stress fracture before and after percutaneous screw fixation

Postop Metaphyseal Diaphyseal 5th met stress fracture

2nd Metatarsal Sress Fracture

 

 

 

Series of Pics demonstrating Progression of 4th metatarsal stress fracture (circled area)

As time goes on, fracture callus is laid down to heal the stress fracture.

 

 

 Intraop pics of 5th metatarsal metaphyseal-diaphyseal stress fracture during repair.  We clean out the nonunion fracture and then applied bone graft from the patient's heel into the void to stimulate healing.  A screw is then placed across the fracture site.