Metatarsal Stress Fractures (long bones of the foot)
What is a Metatarsal Fracture?
Metatarsal fracture is a break in one of the long bones of your foot that connect the ankle to the toe. It is a common foot injury among those with an active lifestyle, and it requires careful assessment and management depending on the type and position of the fracture. Call our clinic in Gold Coast or Brisbane if you are experiencing metatarsal pain and symptoms like difficulty walking, swelling, bruising, or tenderness in your foot.
Types of Metatarsal Fractures
There are 5 metatarsals numbered 1 through 5 with each corresponding to a toe. The 1st metatarsal corresponds to the big toe and the 5th metatarsal corresponds to the little toe and is most commonly broken. Many metatarsal fractures occur at the base of the fifth metatarsal in line with the little toe. This bone more often fractures at the proximal end closer to the ankle than the distal end closer to the toe or shaft.
5th Metatarsal Fracture
5th metatarsal fractures can often be managed with non-surgical treatment such as protected weight-bearing, that is avoiding pressure through the front of the foot. They can take longer to heal if repetitive pressure is applied (through walking or “weight bearing”). Sometimes these fractures extend into the joint where the fifth metatarsal joins onto the adjacent bones (either the 4th metatarsal or cuboid bone). Fractures into the joint (intra-articular fractures) that are displaced often require surgery. However most occur through the base of the metatarsal not through the joint. Sometimes a CT scan is performed to check if the fracture extends into the joint.
2nd, 3rd and 4th Metatarsal Stress Fractures
Proximal 4th, 3rd and 2nd metatarsal fractures often need to be checked for underlying ligament injuries with an MRI scan or CT scan. A Lisfranc injury can sometimes go unnoticed and may require surgery with problems down the track if it doesn’t heal appropriately.
Distal fractures of the 2nd and 3rd metatarsals occur from repetitive walking, running or from bone issues, and cause pain in the front of the foot. They seldom show up on an x-ray, and usually require an MRI or bone scan to be diagnosed. These fractures require non-surgical treatment with protected weight bearing. Acute metatarsal stress fractures take much longer to heal and can require months of monitoring and strict avoidance of pressure through the front of the foot.
Acute Metatarsal Fracture Assessment & Management
The initial management of acute metatarsal fractures focuses on:
- RICE protocol (Rest, Ice, Compression, Elevation)
- Metatarsal stress fracture pain and swelling management.
- Neurovascular assessment of foot circulation and nerve function.
- X-rays evaluation including weight-bearing views when possible.
- Fracture pattern, displacement, and stability assessment.
Metatarsal Stress Fracture Treatment
Non-invasive Management
Most metatarsal stress fractures can be managed with non-invasive treatments like immobilisation or protected weight bearing depending on the fracture location and pattern.
Protected weight-bearing devices reduce the weight on the foot allowing the metatarsal bone to heal. Typical weight bearing treatments can take 6-8 weeks. The initial 2-3 weeks is with crutches to avoid any stress on the foot. This is followed by partial weight-bearing, and eventually graduating to full weight-bearing as tolerated. Here are the main weight-bearing devices used in treating metatarsal stress fractures:
- CAM walker boot or moon boot
- Post-operative shoe with rigid sole (looks like a sandal)
- Hard-sole shoe with metatarsal pad
- Custom-made orthoses (expensive)
- Pneumatic walking boot (pumps up with air cushion)
Immobilisation (less common):
- Elastic bandaging
- Below-knee cast for unstable fractures
- Moon boot and CAM walkers
- Forefoot offloading devices (a shoe with a large heel to prevent weight bearing on the front of the foot)
Surgical Management
Metatarsal fracture symptoms that indicate surgical treatment:
- Displaced metatarsal fractures
- Fractures with ligament involvement (Lis-Franc injuries)
- Multiple metatarsal fractures
- Intra-articular fractures (displaced fractures in the joints)
- Unstable fracture patterns
- Failed non-surgical management (not healing)
- 5th metatarsal “Jones” fractures
- Professional athletes who may desire expedited return
Surgical Techniques:
- K-wire fixation (temporary pins)
- Plate and screw fixation
- Intramedullary screw fixation (rods or pins inside the bone)
- External fixation in complex cases
Regular Monitoring and Follow-up:
- Initial X-rays at presentation
- Follow-up X-rays at 1 or 2 weeks to ensure alignment
- Further imaging at 6-12 weeks to assess healing
- Final imaging prior to post fracture physiotherapy and graduated return to activities
Metatarsal fractures take months to rehabilitate and regain normal function after healing.
Metatarsal Stresss Fracture Rehabilitation Protocol
Early Phase (0-6 weeks):
- Protected weight-bearing
- Regular wound care if surgical
- Toe mobilisation exercises
- Ankle pump exercises
- Ice therapy for swelling
Intermediate Phase (6-12 weeks – if fracture healed):
- Progressive weight-bearing
- Gentle range of motion exercises
- Proprioception training
- Graduated strengthening exercises
- Gait training
Late Phase (3-6 months):
- Sport-specific exercises
- Impact activity progression
- Return to running program
- Functional training
- Balance and proprioception advancement
Physiotherapy Program
Initial Phase
- Pain management
- Oedema control
- Maintaining mobility of unaffected joints
- Gait training with assistive devices
Progressive Phase
- Joint mobilisation
- Soft tissue techniques
- Strengthening exercises
- Balance training
- Proprioception exercises
Return to Activity Phase
- Sport-specific training
- Impact absorption exercises
- Agility drills
- Functional movement patterns
Potential Complications in Metatarsal Stress Fractures Recovery
Early Complications
- Displacement
- Delayed union
- Stiffness
- Compartment syndrome
- Infection due to surgery
- Complex regional pain syndrome
Late Complications
- Nonunion
- Malunion
- Post-traumatic arthritis
- Chronic pain
- Transfer metatarsalgia
Management of Complications
- Physiotherapy for stiffness
- Surgery if required
- Extended immobilisation for delayed union
- Custom orthotics for residual symptoms
- Pain management programs
- Modified activity programs
Return to Activity Guidelines
- Gradual return based on fracture healing
- Pain-free walking without aids
- Adequate strength restoration
- Normal range of motion
- Sport-specific conditioning achieved
- Typically 8-12 weeks for non-invasive cases and 12-16 weeks for surgical cases
Prevention of Future Injuries
- Appropriate footwear
- Regular stretching
- Gradual activity progression
- Attention to training surfaces
- Proper warm-up routines
- Regular bone health assessment
The successful management of metatarsal fractures requires a comprehensive approach with careful attention to initial assessment, appropriate choice of treatment modality, and structured rehabilitation. Regular monitoring and adjustment of the treatment plan ensures optimal outcomes and minimises complications.
When should I seek urgent medical care?
Seek prompt care if:
- You cannot bear weight
- Pain or swelling is worsening
- There is visible deformity
- Numbness, colour change, or severe bruising occurs
Who should assess and manage a metatarsal fracture?
Assessing a metatarsal fracture may involve a GP, emergency clinician, podiatrist, physiotherapist, or orthopaedic specialist, depending on severity and local referral pathways. Talk to us today if you need your injury assessed.
What is the 5th metatarsal stress fracture recovery timeframe?
While the recovery timeframe of a 5th metatarsal fracture depends on the exact injury location, severity, and treatment plan, a typical non-displaced (hairline) metatarsal stress fracture can take 6 to 8 weeks to heal with rest and restricted activity. It may require a walking boot, limited to no weight-bearing initially, and gradual return to activity with your doctor’s approval. In case your injury requires a surgery, it may take longer for you to make full recovery.
What is the difference between a Jones fracture and other 5th metatarsal fractures?
The 5th metatarsal can actually fracture in 3 different locations and its management and recovery time may vary depending on the type of fracture and severity:
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Avulsion fractures also known as dancer’s fracture occur at the base and often heal well.
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Jones fractures is the most commonly used term for metatarsal fractures that occur farther from the base and have a higher risk of delayed healing.
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Stress fractures occur further along the shaft and develop gradually from overuse. These are most common among athletes
When can I return to sports or work after a stress fracture?
Most people who have suffered a metatarsal stress fracture tend to return to light activity after 6–8 weeks, but getting back to physical sports may require 3 months or more depending on the severity of your injury.
Can I walk on a fractured 5th metatarsal?
Walking isn’t recommended when you’ve suffered a metatarsal stress fracture, unless allowed by your doctor. Walking on a fractured foot too soon can delay the healing process or worsen the injury. Its important to reduce the weight-bearing immediately.
Which is the best type of shoe or boot after a metatarsal fracture?
Wearing the right shoe at each stage of metatarsal fracture recovery protects your healing bone, reduces pain, and helps you safely get back on your feet.
Early Recovery (First Few Weeks)
A CAM walking boot or post-operative shoe is used to limit movement through the forefoot and protect the fracture while healing begins. These allow safe, controlled weight-bearing when appropriate and should have a rigid, rocker-bottom sole with adjustable straps.
Mid Recovery (As Pain and Swelling Improve)
Once symptoms reduce, transition to a stiff-soled, supportive walking shoe. This helps decrease stress on the healing bone while allowing a gradual return to normal walking. The shoe should provide firm midfoot support, a stiff or rocker sole, low heel height, secure fastening, and a wide toe box.
Late Recovery (After Clinical Review)
As function improves, progress to supportive everyday footwear or a structured running shoe to tolerate increased activity. Suitable shoes offer a firm midsole, good shock absorption, and minimal flexibility at the forefoot.
We offer a range of removable casts, braces, boots for limb injuries and fractures. Some people benefit from temporary insoles, particularly during the transition phase, however, the use is individual and should be guided by a health professional.
Which type of footwear should I avoid while recovering from a metatarsal fracture?
These are the types of footwear to avoid during your recovery from metatarsal fractures:
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Thongs, flip-flops or slides
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Ballet flats or flexible shoes
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High heels
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Barefoot walking (early stages)
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Worn-out or unsupportive footwear
