Fatigue/stress fracture of the distal ⅓rd of one of the metatarsals occurring because of recurrent stress.
- M/C 2nd > 3rd metatarsal
- Common in college athletes and the military (25% of all stress fractures)
First described in 1855, termed after the foot pain and swelling experienced by Prussian soldiers on long marches.
- Soldiers during sustained periods of marching.
- Runners (M/C in metatarsal neck)
- Dancers (M/C in proximal shaft)
- Ballet dancers (M/C at base of 2nd metatarsal and at Lisfranc joints)
- Associated conditions:
- Cavus feet
- Gradual onset
- Cramp-like pain in affected forefoot when boot/shoes are taken off
- Moderate local oedema (dorsal aspect)
- Pain on moving each toe in turn, that of the involved metatarsal
- Palpation from dorsal surface, a point of tenderness is found directly over the lesion.
- Acute metatarsal fracture
- Hallux rigidus “stiff big toe”
- Degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux (big toe)
- Jones fracture
- Fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, without joint involvement.
- Sesamoid stress fracture
- Acute sesamoid fracture
- Proximal fifth metatarsal avulsion fracture
- First-line treatment: Immobilization (6-12 weeks) with cast
- Stress fracture with a cavus foot: Plantar fascia release