Symptoms of a fatigue fracture of the metatarsus

In contrast to a fracture caused by an accident, which is characterized by sudden severe pain and often loss of function of the affected limb immediately after the trauma, a fatigue fracture of the metatarsus develops only gradually and thus its symptoms as well. Thus, the first pain symptoms in the metatarsal area are often already noticed during the bone overload, but these disappear again when the patient is at rest. Since the pain in the early stages only occurs when the foot is strained, it is often not taken seriously and is ignored.

If the affected foot is subjected to further strain, the pain, which is initially only load-dependent, later persists even in rest phases, and gradually leads to any occurrence with the foot being painful and thus avoided. Thus, a fatigue fracture ultimately leads to a gradual reduction in the load-bearing capacity of the metatarsus and thus to a loss of function of the foot. The pain described here is characterized as dull pressure pain in the foot area. Occasionally, symptoms such as swelling, reddening, overheating and bruising (haematomas) in the metatarsal area also occur as a concomitant symptom of the fatigue fracture.

Diagnosis

The diagnosis of a fatigue fracture of the metatarsus is difficult due to the gradually developing and often unspecific symptoms, and is therefore often made relatively late. First of all, the anamnesis attempts to narrow down the cause of the pain by asking specific questions. Here it is of interest to know how long the pain has existed, whether it occurs only under stress or already at rest, and whether a triggering trauma is underlying.

During the subsequent physical examination, the physician will look for signs that indicate a fracture, such as axial malposition and abnormal mobility of the metatarsus or whether bone rubbing (crepitations), swelling, redness or bruising are present. The next step in diagnostics is imaging. First, an x-ray is taken, with which the bone fracture can at best already be detected, or other causes can be excluded, such as the exclusion of a rheumatic disease that may have similar pain symptoms.

Often, however, especially in the early stages of the fatigue fracture, an X-ray image is not clear. For further diagnostic purposes, procedures such as computed tomography (CT), magnetic resonance imaging (MRI) or scintigraphy are performed, which allow a good and usually reliable diagnosis. The treatment of a fatigue fracture of the metatarsus is usually performed conservatively, i.e. without surgery.

Here, the most important measure is the protection of the foot, on the one hand by strictly avoiding any stress, on the other hand by immobilizing the metatarsus in a plaster cast or a so-called forefoot relief shoe. During immobilization, which usually lasts four to six weeks, the bone can regenerate and thus stabilize. If the fracture is due to an organic cause such as osteoporosis, this cause must be treated adequately to prevent further fractures.

Painkillers, cooling and elevation of the foot are used to treat the symptoms. Additional measures such as lymph drainage, kinesiotapes or physiotherapy can also have a positive effect on healing the fatigue fracture and accelerating bone regeneration. If the metatarsal fracture is diagnosed at a very late stage or if it is severe and treatment cannot be successfully achieved by immobilization, in some cases surgical treatment of the fracture by fixing the fragments with wires and screws and then immobilizing them in plaster may be necessary.