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Stress injuries of the feet and legs are some of the more common ailments treated in our office amongst running, jumping, and pivoting sport athletes. And the most common area for stress fracture of the foot is to the second metatarsal. Approximately one third of people have a longer second metatarsal than the first and third metatarsal. In addition, the second metatarsal is less mobile than other metatarsals and therefore, cannot dissipate the stress placed upon it. Under these anatomical variants, when the foot pushes off the ground, there is increased pressure to the second metatarsal, and over time this causes microtrauma to the bone. A very small hairline disruption in the bone may occur, and not seen on x-ray until bone healing occurs. Often times, it takes 10-14 days for the healing calcium to be noted on x-ray. However, at our office, through a careful examination, we can feel and pinpoint the area of disruption/inflammation and make a proper diagnosis. In extenuating circumstances, an MRI is ordered for a quick confirmative diagnosis.

Most importantly, stress fractures do not heal well until the stress is taken away from the metatarsal. Treatment to reduce the stress is often initiated with immobilization via a fracture shoe or boot. After healing, the stress must be eliminated to the metatarsal or the injury is bound to recur. Custom orthotics are usually necessary to treat stress fractures related to microtrauma or when there is a long second metatarsal. Stress fractures occur less often to other metatarsals and if one occurs, there may be anatomical malalignment of the metatarsal including a dropped metatarsal, which needs to be adequately addressed. Finally, shoe gear, running/playing surfaces, and running form all needs to be adequately addressed at ones’s visit to our office. Should you or someone you know require specialized care of a stress fracture, please do not hesitate to call our office for an appointment.

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Written by Richard T. Braver, DPM, FACFAS

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