What causes acute metatarsal fractures?
Acute metatarsal fractures can be caused by direct injury to the foot. This may happen, for example, through someone stepping on or kicking the foot, by dropping something on to the foot or by falling on to the foot. Twisting of the foot or the ankle can also cause fractures of the base of the fifth metatarsal. In this injury, the twisting mechanism pulls on a strong ligament that attaches to the base of the fifth metatarsal which then pulls off a fragment of bone. The shaft of the metatarsal is commonly injured because of twisting of the foot on landing from a jump. This is a common problem in ballet dancers.
What causes metatarsal stress fractures?
Metatarsal stress fractures generally occur due to repeated stress to the bone, which is also termed overuse. They most commonly affect the second and third metatarsal bones, as these bones have the most amount of stress placed on them when you are moving. Metatarsal stress fracture is typically seen in those who have marched or run for long distances, especially if carrying heavy packs.
Stress fractures often affect athletes and sportsmen, although they can affect any runners, even those who only run a little. They are commonly seen in the military during training exercises.
They are common in runners who:
- Suddenly increase their running mileage or intensity.
- Run in poor footwear that doesn't suit their feet.*
- Have just changed their running shoes and not 'broken them in' carefully.
- Continue to exercise despite having foot pain.
They are also frequently seen in ballet dancers and gymnasts.
*People's choices and needs for running shoes vary. However, before choosing something unusual such as barefoot shoes or corrective shoes, make sure you have some advice. For example, for barefoot running you need to be taught the right technique. Break in new running shoes gradually - many injuries result from a sudden change in running shoes.
Abnormalities of the structure of the foot, and abnormalities of the bones and joints, such as rheumatoid arthritis or 'thinning' of the bones (osteoporosis), can make stress fractures more likely. Stress fractures can also occur in people who have lost nerve sensation in their feet due to neurological problems - for example, diabetes that has affected the feet.
Does osteoporosis cause metatarsal fractures?
Metatarsal fractures (of both types) occur more easily if the metatarsal bones are weakened due to 'thinning' of the bones (osteoporosis).
Does ageing make metatarsal fractures more likely?
Most metatarsal fractures occur in younger people, as they are more likely to be involved in the kinds of sports and marching activities that make them more likely. However, as we get older the 'springiness' and padding of our feet tend to reduce. This means that our feet absorb impact less well and it is easier to fracture bones. Supportive footwear will make this much less likely.
Further reading and references
Fredericson M, Jennings F, Beaulieu C, et al; Stress fractures in athletes. Top Magn Reson Imaging. 2006 Oct17(5):309-25.
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