I. Epidemiology

  1. Second and Third Metatarsals most commonly involved
    1. Military recruits (March Fracture)
    2. Ballet Dancers (associated with dance on toe tips)
    3. Sanderlin (2003) Am Fam Physician 68:1527-32 [PubMed]
  2. Fifth Metatarsal Stress Fractures are least common
    1. Associated with Genu Varum
    2. Differentiate from Jones Fracture
    3. Increased risk of nonunion
    4. Harmath (2001) Orthopedics 24:111 [PubMed]

II. Symptoms

  1. Localized pain at Fracture site
    1. Initially pain onset only with activity

III. Signs

  1. Metatarsal Head Axial loading test positive (see Metatarsal Fracture)
  2. Point tenderness over Fracture site

IV. Imaging

  1. XRay
    1. Fracture line usually not present for 2-6 weeks from onset of Fracture
  2. MRI or Bone Scan are more sensitive
    1. Not necessary if Stress Fracture treated empirically based on clinical findings

V. Management

  1. Type 1: Acute Fracture without XRay changes
    1. Often heals well without immobilization
    2. Option 1
      1. Avoid offending activity for 4-8 weeks
    3. Option 2 (if painful ambulation despite Option 1)
      1. Crutch walking with partial weight bearing for 1-3 weeks
    4. Option 3 (if severe pain despite Option 2)
      1. Immobilize with short-leg cast and non-weight bearing for 1-3 weeks
  2. Type 2: Delayed union with wide Fracture line
  3. Type 3: Recurrent symptoms and established non-union
    1. Manage surgically with internal fixation

VI. Prevention

  1. See Stress Fracture
  2. Gradually return to prior activity
  3. Custom Orthotic may be considered in some cases (e.g. long second Metatarsal)

VII. Course

  1. Variable healing by conservative methods in 8-70 weeks

VIII. Complications: Non-union Fracture or Avascular Necrosis

  1. Proximal Fifth Metatarsal Fracture is highest risk
  2. Second Metatarsal Head AVN (Freiberg's Infarction)
    1. Seen in adolescents

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Ontology: Stress Fractures (C0016664)

Definition (MSH) Fractures due to the strain caused by repetitive exercise. They are thought to arise from a combination of MUSCLE FATIGUE and bone failure, and occur in situations where BONE REMODELING predominates over repair. The most common sites of stress fractures are the METATARSUS; FIBULA; TIBIA; and FEMORAL NECK.
Concepts Injury or Poisoning (T037)
MSH D015775
ICD10 M84.3
SnomedCT 23382007, 240197007, 269322004, 208682007, 157252004, 208743001, 263253007
English Fatigue Fracture, Fatigue Fractures, Fracture, Fatigue, Fractures, Fatigue, Fractures, March, Fractures, Stress, March Fracture, March Fractures, Fracture, March, Fracture, Stress, [Q] Stress fracture, stress fracture (diagnosis), stress fracture, [Q]Stress fracture, Stress fracture (disorder), Stress fracture NOS, Stress reaction, Fractures, Stress [Disease/Finding], stress fractures, march fractures, Fatigue fractures, fracture of metatarsal bone(s) march fracture, March fracture (diagnosis), Fatigue fracture, Stress fracture, March fracture, March fracture (disorder), Stress fracture (morphologic abnormality), fatigue fracture, march fracture, fatigue; fracture, fracture; fatigue, fracture; march fracture, fracture; stress, march fracture; fracture, stress; fracture, Stress Fractures, Stress Fracture, Fracture;stress
Italian Frattura da sforzo, Frattura da marcia, Fratture da fatica, Fratture da marcia, Fratture da stress
Swedish Utmattningsfrakturer
Japanese ストレスコッセツ, コウグンコッセツ, 過労性骨折, 骨折-疲労, ストレス骨折, 疲労骨折, 行軍骨折, 骨折-ストレス, 骨折-行軍, 骨折-過労性
Czech fraktury z přetěžování, fraktury stresové, Pochodová zlomenina, Únavová zlomenina
Finnish Rasitusmurtumat
Spanish Fractura de la marcha, Fracturas de la Marcha, Fracturas por Tensión, (Q)fractura por sobrecarga, fractura por estrés, fractura de esfuerzo, fractura por sobrecarga (trastorno), Stress fracture, fractura por fatiga, fractura por marcha (trastorno), fractura por marcha, fractura por sobrecarga (anomalía morfológica), fractura por sobrecarga, Fractura por sobrecarga, Fracturas por Estrés, Fracturas por Fatiga
French Fracture de marche, Fracture de fatigue, Fractures de stress, Fractures de fatigue
Dutch marsfractuur, fractuur; marsfractuur, fractuur; stress, fractuur; vermoeidheid, marsfractuur; fractuur, stress; fractuur, vermoeidheid; fractuur, stressfractuur, Fracturen, stress-, Fractuur, stress-, Marsfractuur, Stressfracturen, Stressfractuur, Vermoeidheidsfractuur
German Marschfraktur, Belastungsfraktur, Frakturen, Marsch-, Marschfrakturen, Ermüdungsbrüche, Ermüdungsfrakturen, Frakturen-, Ermüdungs-, Frakturen, Streß-, Streßfrakturen
Portuguese Fractura da marcha, Fraturas por Fadiga, Fraturas por Stress Mecânico, Fraturas por Estresse Físico, Fractura de fadiga, Fraturas de Estresse, Fraturas de Fadiga, Fraturas de Marcha
Polish Złamania przeciążeniowe
Hungarian March-fractura, Fáradásos törés
Norwegian Marsjfraktur, Marsjbrudd, Tretthetsbrudd, Stressfraktur, Trøtthetsbrudd