Metatarsal stress fractures

[tiger physio]

Does anybody know the recommended time period for non weight bearing for third metatarsal stress fractures? Is it simply a case of when pain free walking can be achieved? Also when is it sensible to commence activities such as aquajogging? Does anyone have any experiences to share of quick recovery from such an injury? Any advice would be greatly appreciated. Thanks.

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[bsandeep]

whats the age of the patient. what type of activity is the patient engaged in. cause of stress fracture ?

[tiger physio]

The patients is 25 and is an avid runner. I believe the cause of the stress fracture was a recent increase in mileage and change of footwear.

[bsandeep]

The treatment depends on the time the diagnosis was made. In cases of fresh injury, rest, ice, elevation and compression (RICE) are very helpful as well as anti-inflammatory medication. An Aircast boot may be used if weight bearing is to be allowed, but an elastic bandage and non-weight bearing status are adequate. Both types of immobilisation plus total rest and refrainment from exercise/sport for 4-8 weeks are necessary. Metaphyseal fractures heal faster than articular or cortical injuries. The patient can begin rehabilitation when pain free but may not necessarily return to sporting activity at that stage. The patient must have a full range of motion, have redeveloped muscle flexibility and developed strength, endurance, proprioception, agility and cardiovascular reserve before returning to full competition. The reason underlying the stress fracture should be determined and preventative measures for future injury instituted. A good training programme, the use of proper footwear, impact surfaces and orthoses can be important preventative measures to decrease the recurrence of stress fractures. The predictive value of bone-mineral density of the calcaneus for fracture of the metatarsals has been studied. Lidtke & Patel (11) reported a positive correlation between calcaneal density and the four-point bending strength of each of the five metatarsals. However, no correlation between density and fractures has been established. This may be a useful predictive tool for the future. In the athlete, a stress fracture is invariable indicative of overuse and, as such, signals the need to investigate training habits, equipment, mechanics and athletic techniques.

[tiger physio]

Thanks for your advice. Fortunately the diagnosis was made early and with the right treatment the patient should expect a good recovery. I will pursue the preventative measures with the patient to minimise the chance of this occuring again in the future.

I take it when you suggested refraining from sporting activity for 4-8 weeks this also includes aquajogging? It is difficult to keep athletes occupied at times of injury and trying to keep cross training activites as representative of their normal activity is a challenge.

With regards to NSAIDs I have advised against this in the initial stages given the increasing body of evidence suggesting the delay in fracture healing through their use.

Thanks again for your assistance. If anyone else has any experiences dealing with this type of injury please feel free to share.

[bsandeep]

yes even aquajogging you are welcome
sandeep bhagwat

[sdkashif]

As there is no displacement, neither reduction nor splintage is required. The fractures heals spontaneously, so treatment is purely symptomatic. The fore foot may be supported by an elastic bandage and normal walking is encourged right from the beginning. In some cases, no treatment is needed; but if pain is severe immobilization in a below knee walking plaster for four week is advised. In short, you may encourge walking right from the beginning but any vigorous activity such jogging should not be statrted before four weeks.