Stress fractures


A stress fracture is a break in a bone caused by repetitive stress. A stress fracture can occur in any bone, but is commonly found in the 2nd and 3rd metatarsal bones of the foot. You can suddenly develop a painful forefoot after some activity, such a walking, running, or squatting onto the ball of the foot. A small crack develops in the cortex (outer shell) of the bone. A stress fracture can progress to a complete or overt fracture of the bone. Metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.


Sharp pain in the forefoot, aggravated by walking
Tenderness on palpation of the top surface of the metatarsal bone.
Diffuse swelling of the skin over the forefoot.
Bruising or redness of forefoot


Decreased density of the bones due to osteoporosis
Unusual stress on a metatarsal due to a compensation of a forefoot deformity such as a bunion
Abnormal foot structure such as a flatfoot
Increased levels of activity without sufficient rest period

If you suspect you have stress fracture you should:

  • Seek medical treatment as soon as possible

  • Keep weight off your foot

  • Ice the top surface of your forefoot for about 20 minutes every hour.

  • To reduce swelling, wrap your foot in a tensor bandage with moderate compression.

  • Wear a shoe with a very stiff sole

The medical treatment for a stress fracture may include:

  • X-rays

  • Bone scans to establish a diagnosis

  • Offloading of stress on the metatarsal with the application of taping and padding

  • Splinting and bracing of the foot with a removable below knee Aircast™.

  • Non-steroidal anti-inflammatory medication.

  • Physical therapy modalities in the later stages of healing.

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