Do I need any investigations?
Your doctor may suggest an X-ray of your foot if they suspect a metatarsal stress fracture.
Acute metatarsal fractures
Most acute metatarsal fractures can be seen easily on X-ray. Initially doctors can see the crack in the bone, and after a few days they can also see irregularities in the bone as it starts to heal and remodel itself. CT scanning or MRI scanning is occasionally needed. The doctors will need to determine if the fracture is displaced, which may mean that the bones need to be re-aligned and held in place. This is quite common in acute metatarsal fractures, as the weight of your body tends to push down on the broken bone and this can force the two broken ends slightly apart.
Metatarsal stress fractures
Stress fractures do not show up as easily on X-ray, particularly not at first. Half of them never show up on a normal X-ray. There can be multiple, very tiny fractures and splits in the bone, or just one fine crack which doesn't go right through the bone. Because they have formed very gradually, the bone may not have 'reacted' very much to the injury.
Metatarsal stress fractures can usually be seen by using a bone scan to look at your foot. This bone scan involves an injection of a very small amount of radioactive material, usually into a vein in your arm. A gamma camera is then used that can detect the radiation emitted by the injected material. This can show up a stress fracture.
MRI scanning is also sometimes used to find stress fractures.
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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