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I saw a runner recently with a gradual onset of lateral foot pain and swelling. Symptoms had worsened after a race and walking was now painful and difficult. They had no early morning stiffness but did report pain at night. This history combined with bony tenderness on palpation raised my suspicions for a fifth metatarsal stress fracture.

These are considered high risk due to the impaired blood supply in that region which can delay healing. This depends on the location of the stress fracture:

Graphic adapted from Zwitser and Breederveld (2010).

Surgery is sometimes required and it often means a lengthy period away from sport so if you suspect a high-risk stress fracture it’s best to arrange an investigation asap. This will help determine the location and severity of the bone stress injury.

An X-ray is a sensible first step to rule out a true fracture but will often miss stress fractures. MRI is considered gold standard although fifth metatarsal stress fractures can sometimes be seen on ultrasound.

If you are highly suspicious of a stress fracture it may be necessary to provide crutches and recommend a period of partial or non-weight bearing, especially if there is pain while walking.

In our runner’s case fortunately the MRI ruled out a stress fracture which allows us to press on with rehab and be guided by symptoms without concern of a more serious injury.

To learn more about assessment and treatment of stress fractures and all key running injuries join us on the Running Repairs Course. Click here to find out more.