Footcare Scotland - The Foot & Ankle Experts
Edinburg Orthopeadic Ankle Surgeon

Metatarsal Stress Fracture

As anyone who has had a metatarsal stress fracture will tell you, it is a painful and extremely frustrating injury.  You have trained hard for that event and all of a sudden, and without much warning, you have developed a stress fracture.  Metatarsal stress fractures are common place in the sporting community but what are they and what causes them?

The metatarsals are 5 long bones in your foot, leading to the toes.  Metatarsal stress fractures are an overuse injury of these bones.  This type of fracture is caused in 2 scenarios.  Either where normal, healthy bone is unable to keep up with the repair process when it is put under excessive stress.  Or where structurally abnormal bone, due to conditions such as osteoporosis, is put under normal stresses and cannot cope (this is known an insufficiency fracture).

What causes Stress Fractures?

There are many factors that contribute to the development of metatarsal stress fractures. Extrinsic factors such as training load, inadequate recovery and activity type are common factors.  There are also intrinsic factors such as sex, poor nutrition, low body weight, low bone density and poor conditioning.

The most common cause is a sudden increase in the levels your activity.  Either increasing the frequency of your training or increasing the duration or intensity of your training can contribute to a stress fracture.

Conditions that reduce your bone density, such as osteoporosis, also increase your risk of stress fractures.  Studies have shown that female athletes are more likely to develop stress fractures.  This may be due to what is known as the ‘female athlete triad’.  This is 3 inter-related conditions that will lead to a decrease in bone mass- eating disorders, menstrual disfunction and premature osteoporosis.

What are the symptoms of a metatarsal stress fracture?

Metatarsal stress fractures most commonly occur in the 2nd and 3rd metatarsals of the foot.  There is generally tenderness or pain to the touch along these bones.  There may also be some swelling or bruising to the top of your foot.  Other common symptoms include pain that improves with rest and pain with normal daily activities as well as with running/jumping.

What should I do if I suspect I have this injury?

We recommend that you see a suitably qualified medical professional as soon as possible.  Ignoring the pain isn’t likely to get you very far and will only increase your recovery time.  Before you see your Podiatrist, Physio or doctor, follow the PRICE protocol- Protect, Rest, Ice, Compression, Elevate.


Your Podiatrist will discuss your general health, diet and take a detailed history of your training program and the onset of your pain.  Your foot will then be examined and your Podiatrist will look for the most painful area by applying gentle pressure over the area of the injury.  Pain from stress fractures is typically limited to the area directly over the injured bone.  On occasion we may order some imaging to help with the diagnosis.  X-rays can be helpful but the fracture may not be visible until several weeks later when it has actually started to heal.  Other imaging studies such as MRI are also helpful where we cannot see it on x-ray.


The goal of treatment is to reduce your pain and to allow the bone the best chance of healing as quickly as possible.  Just because you have a metatarsal stress fracture doesn’t mean that you cannot continue to exercise.  However we may need to modify what activities you are doing.  For example, running may not be possible but we can replace this with swimming or cycling.  In some cases protective footwear is recommended.  This can vary from a stiff soled shoe or boot to a remove-able fracture boot.


Bone generally takes between 6-8 weeks to heal.  We understand that being sidelined with an injury is frustrating but returning to activity too soon can result in you being out for an extended period of time.  Re-injury of the bone can lead to more persistent issues.  It is therefore very important to follow any recommendations by your Podiatrist, Doctor or Physio.


As always, prevention is better than the cure:

  • Eating a healthy diet with plenty of calcium and Vit. D will help build strong bones.
  • Gradually increase the distances and intensity of your activity to avoid over training.
  • Try mixing up your training.  Replace a run with a swim or a cycle
  • Add some strength training with weights or resistance bands
  • Use the proper equipment.  Those old worn out shoes aren’t fit for purpose, treat yourself to a new pair of trainers.


If you suspect you gave a stress fracture or other foot or ankle injury you can book an appointment with one of our team HERE