What are the symptoms of an acute metatarsal fracture?
An acute metatarsal fracture may make an audible sound at the time of the break and you will usually have immediate pain and tenderness around the area of the fracture. The pain is often called 'pinpoint pain' as it is quite well localised at the site of impact to the bone.
Broken bones bleed, so bruising and swelling can develop and you may have difficulty putting weight on the affected foot. Movement of your foot may also be limited. Surprisingly, however, pain can settle within a few hours.
People sometimes say that it isn't possible to walk on a broken foot but this is not correct. Whether you can walk on a broken foot depends on which bone is broken (and whereabouts along its length), whether the fracture is displaced, how supportive your shoes are, and on your personal tolerance to pain. It is, therefore, possible to walk on a broken foot, although it is likely to be very uncomfortable to do so and it may well make matters worse if you do.
What are the symptoms of a metatarsal stress fracture?
Stress fractures cause similar symptoms to acute metatarsal fractures, although there is usually no bruising and no cracking sound. At first, the main symptom may just be pain in the foot during exercise that is relieved by rest. After a while, the pain may become continuous, so that it is not relieved by resting.
To begin with, pain tends to be widespread and diffuse in the foot. As the stress fracture progresses, the sore area tends to become more localised to the area of the fracture, and the pain gradually increases. Typically the stress fracture then causes a tender area along the line of the second or third metatarsal bone. There may be some swelling but there is usually no bruising.
People who have stress fractures may continue to walk for some time. Eventually this becomes increasingly painful, as the splits in the bone tend to worsen and the bone itself starts to react and become inflamed, and it can become impossible to weight bear. A metatarsal stress fracture can progress to become a full-thickness fracture.
Will the pain increase?
Metatarsal stress fractures can begin as very small injuries which do not cause severe pain. However, if you carry on stressing the bone, the crack will often deepen and widen, becoming gradually more painful. Eventually, in the worst case scenario, the stress fracture may progress to become a full fracture.
If you have an acute fracture and you continue to stress the bone, the pain will increase further as the broken ends of bone will start to rub slightly against one another, and the area will become inflamed. In the worst case scenario the fracture may become displaced.
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.
I broke 2nd, 3rd & 4th metatarsels, non displaced. I was told it's really bad injury. in week 6 the cast was removed and the doctor at the clinic gave me a long boot and told me to gradually begin...CatNip1uk
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