Fatigue Fracture

Overview

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 5 metatarsal bones in each foot. They are located in the area between the toes and the 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 the 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

SymptomsandDiagnosis

Symptoms

A march stress fracture may cause pain in the middle or front of the foot. There may be swelling. The foot will feel better when resting and feel 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:

  • X-ray
  • MRI scan
  • CT scan

Treatments

Treatment

Stress fractures are treated with rest and nonsteroidal anti-inflammatory drugs (NSAIDs). The foot will need rest for 3-6 weeks. Crutches may be needed to avoid bearing weight on the foot. Sometimes a brace or cast is used for a short time to aid healing.

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.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

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

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 

When it Hurts to Move—Canadian Orthopaedic Foundation http://whenithurtstomove.org 

References

Fractures (broken bones). Ortho Info—American Society of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00139&return%5Flink=0. Updated October 2012. Accessed August 30, 2017.

Metatarsal stress fractures. Sports injury website. Available at: http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/metatarsal-fracture. Accessed August 30, 2017.

Stress fracture. Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/sports%5Finjury/stress%5Ffractures.html. Updated October 2014. Accessed August 30, 2017.

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 30, 2017.

4/24/2014 DynaMed Plus Systematic Literature Surveillance  http://www.dynamed.com/topics/dmp~AN~T114482/Decision-rules-for-imaging-of-ankle-and-foot-injuries : Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: https://acsearch.acr.org/docs/69424/Narrative. Updated 2013. Accessed August 18, 2014.