March Stress Fracture

(Stress Fracture, March; Stress Fracture of Metatarsal Bone; Fatigue Fracture)

Definition

A march stress fracture is a small break in a metatarsal bone of the foot that occurs without a major traumatic episode. There are five metatarsal bones in each foot. They are located in the area between your toes and your ankle. They were called march fractures because they were first seen in military recruits because of excess marching. These fractures still occur in that group.
March Stress Fracture
Stress fracture foot
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Causes

A march stress fracture is an overuse injury caused by repetitive stress to the foot.

Risk Factors

Factors that may increase your chance of getting a march stress fracture include:
  • Participation in high foot impact sports, such as:
    • Running
    • Basketball
    • Dancing
    • Jumping events in track
  • Military service
  • Feet with high arches
  • Use of poor or improper footwear
  • Osteoporosis
  • Female runners with amenorrhea (absent menstruation), osteoporosis, or an eating disorder

Symptoms

A march stress fracture may cause pain in the middle or front of the foot. You may notice swelling. Your foot will feel better when resting and worse with activity.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist. An orthopedist focuses on bones. A sports medicine physician works on sports-related injuries.Imaging tests evaluate the bones in your foot and surrounding structures. These may include:

Treatment

Stress fractures are treated with rest and nonsteroidal anti-inflammatory drugs (NSAIDs). You will need to rest your foot for 3-6 weeks. Your doctor may recommend crutches for a week or two so that you don’t put any weight on your foot. Sometimes a brace or cast is used for a short time to aid healing. Once you are able to move without pain, your doctor will allow you to return to normal activities. Gradually increase your activity over several weeks.

Prevention

To help reduce your chance of a march stress fracture, take the following steps:
  • Wear shock-absorbing insoles when running or during other high-impact exercise
  • When starting a new sport or increasing your workout, do so gradually
  • Choose footwear that takes into account the specific sport and your type of foot

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RESOURCES

American Academy of Podiatric Sports Medicine
http://www.aapsm.org

Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org

Canadian Orthopaedic Foundation
http://www.canorth.org

References

Fractures (broken bones). American Society of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00139&return%5Flink=0. Updated October 2012. Accessed August 18, 2014.

March fracture. DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed August 18, 2014.

Metatarsal stress fractures. Sports injury website. Available at: http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/metatarsal-fracture. Accessed August 18, 2014.

Stress fracture. Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/sports%5Finjury/stress%5Ffractures.html. Updated November 2010. Accessed August 18, 2014.

What is a stress fracture and how should it be treated? American Academy of Podiatric Sports Medicine website. Available at: http://www.aapsm.org/ct0398.html. Accessed August 18, 2014.

4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed August 18, 2014.

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