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Injury Description

The metatarsus or metatarsal bones are a group of five long bones in the foot located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes. Lacking individual names, the metatarsal bones are numbered from the medial side (side of big toe): the 1st, 2nd, 3rd, 4th, and 5th metatarsal. The metatarsals are analogous to the metadarpal bones of the hand. Many times the metatarsals will be fractured though the impact of hitting football studs or through a hard collision. These injuries are more common with the new lightweight football boots giving less protection.

Signs and Symptoms

Pain in the forefoot area which is made worse by physical activity and movement of the foot. The area around the bone will feel tender and these may be immflamation.

Causes

These types of fractures are generally attribured to overuse. Weakened bones are suspect to fracture then on high impact. The gradual onset of of a stress fracture is often the case.

Treatment

If a or impact metatarsal fracture occurs in a weight-bearing bone, healing will be delayed or prevented by continuing to put weight on that limb.

Rest is the only option for complete healing of a stress fracture. The amount of recovery time varies greatly depending upon the location, severity, the strength of the body's healing response and an individual's nutritional intake. Complete rest and a cast or walking boot are usually used for a period of four to eight weeks, although periods of rest of twelve to sixteen weeks is not uncommon for more severe stress fractures. After this period activities may be gradually resumed, as long as the activities do not cause pain. While the bone may feel healed and not hurt during daily activity, the process of bone remodeling may take place for many months after the injury feels healed, and incidences of re-fracturing the bone is still at significant risk. Activities such as running or sports that place additional stress on the bone should only gradually be resumed. One general rule is to not increase the volume of training by more than 10 percent from one week to the next.

Rehabilitaition usually includes muscle strength training to help dissipate the forces transmitted to the bones.

Bracing or casting the limb with a hard plastic boot or air cast may also prove beneficial by taking some stress off the stress fracture. An air cast has pre-inflated cells that put light pressure on the bone, which promotes healing by increasing blood flow to the area. This also reduces pain because of the pressure applied to the bone. If the stress fracture of the leg or foot is severe enough, crutches can help by removing stress from the bone.

With severe stress fractures, surgery may be needed for proper healing. The procedure may involve pinning the fracture site, and rehabilitation can take up to six months.


Prevention

One method of avoiding stress fractures is to add more stress to the bones. Though this may seem counter-intuitive (because stress fractures are caused by too much stress on the bone), moderate stress applied to the bone in a controlled manner can strengthen the bone and make it less susceptible to a stress fracture. An easy way to do this is to follow the runner's rule of increasing distance by no more than 10 percent per week. This allows the bones to adapt to the added stress so they are able to withstand greater stress in the future.

References

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