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# Metatarsal fractures (including stress fractures)

Metatarsal fractures are breaks in the long bones of the forefoot, from an injury or from repeated loading (a stress or «march» fracture).

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Second metatarsal](https://durgical.com/en/anatomy/second/)
- [Fifth metatarsal](https://durgical.com/en/anatomy/fifth/)
- [Third metatarsal](https://durgical.com/en/anatomy/third/)
- [Fibularis brevis](https://durgical.com/en/anatomy/fibularis-brevis-muscle/)
- [First metatarsal](https://durgical.com/en/anatomy/first/)
- [Fourth metatarsal](https://durgical.com/en/anatomy/fourth/)
- [Lisfranc ligaments](https://durgical.com/en/anatomy/cuneometatarsal-interosseous-ligaments/)
- [Plantar fascia](https://durgical.com/en/anatomy/plantar-aponeurosis/)
- [Cuboid](https://durgical.com/en/anatomy/cuboid-bone/)
- [Dorsalis pedis artery](https://durgical.com/en/anatomy/dorsalis-pedis-artery/)

## Why it happens

- [Bone remodeling](https://durgical.com/en/physiology/bone-remodeling/)
- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

A break in one of the five metatarsal bones of the forefoot, either acute from injury or a stress fracture from repeated loading. The [second metatarsal](https://durgical.com/en/anatomy/second/) «march fracture» and fractures of the base of the fifth metatarsal are the classic types.

## Who gets it

Metatarsal fractures are among the most common foot fractures. Stress fractures occur in runners, soldiers in training and dancers; acute fifth metatarsal fractures often follow an ankle twist.

## Causes

- Inversion injury of the foot (avulsion of the fifth metatarsal base)
- Direct blow or crush injury
- Repeated loading with a sudden increase in training, such as marching or running (stress fracture)
- Low bone density (insufficiency fracture)

## Risk factors

- Sudden increase in training volume or intensity
- Military training
- Low energy availability, menstrual disturbance or low bone density in athletes
- Low vitamin D
- Cavus or flat foot and hallux valgus that shift load
- Osteoporosis, diabetes with neuropathy

## Pathophysiology

In a stress fracture, repeated loading causes microdamage faster than bone can remodel it. The long, fixed second metatarsal takes high loads at push-off, so it is the usual site. At the base of the fifth metatarsal, the pull of [fibularis brevis](https://durgical.com/en/anatomy/fibularis-brevis-muscle/) and the [plantar fascia](https://durgical.com/en/anatomy/plantar-aponeurosis/) causes avulsion, while the metaphysis–diaphysis junction (Jones zone) has a poor blood supply and heals slowly.

## Classification

- Acute traumatic or stress fracture
- By bone (first to fifth) and site: head, neck, shaft or base
- Fifth metatarsal base: zone 1 tuberosity avulsion, zone 2 Jones fracture, zone 3 proximal shaft stress fracture
- Displaced or non-displaced; open or closed

## Symptoms and signs

- Forefoot pain on weight bearing
- Local swelling and bruising after injury
- Point tenderness over the bone
- In stress fractures, pain that starts gradually with activity and later persists at rest

## Red flags

- Tense, very painful swollen foot after a crush injury (foot compartment syndrome)
- Open wound over the fracture
- Pain at the base of the second metatarsal with plantar bruising (suspect Lisfranc injury)
- Numbness or poor circulation of the toes

## Diagnosis

**Clinical**
Point tenderness over the metatarsal; the Ottawa foot rules (tenderness at the [fifth metatarsal](https://durgical.com/en/anatomy/fifth/) base or [navicular](https://durgical.com/en/anatomy/navicular-bone/), or inability to bear weight) guide the need for X-rays.

**Tests**
In stress fractures, vitamin D and other bone health tests when risk factors are present.

**Imaging**
Foot X-rays in three views. Early stress fractures are often invisible on X-ray; MRI (or bone scan) shows them, and callus appears on X-ray weeks later. CT for complex patterns.

## Differential diagnosis

- Lateral ankle sprain
- Lisfranc (tarsometatarsal) injury
- Morton neuroma
- Metatarsophalangeal synovitis or plantar plate injury
- Freiberg disease
- Tendinopathy of fibularis brevis

## Goal of treatment

Achieve bone healing in good alignment, control pain and return safely to walking and sport while correcting the cause of overload.

## Treatment

**Conservative**
Most non-displaced shaft fractures and fifth-metatarsal tuberosity avulsions: walking in a stiff-soled shoe or boot as pain allows.

**Conservative**
Jones fracture: a period of non-weight-bearing in a cast or boot because of the risk of delayed healing.

**Medical**
Simple analgesics; sources differ on NSAIDs during fracture healing. Treatment of low vitamin D or low bone density when present.

**Surgical**
Internal fixation for displaced or multiple fractures, and intramedullary screw fixation of Jones fractures in athletes or after nonunion.

**Rehabilitation**
Graded return to impact activity, review of training load, footwear and nutrition.

## Complications

- Delayed union or nonunion, especially of the Jones zone
- Malunion with transfer pain under other metatarsal heads
- Refracture
- Compartment syndrome of the foot after crush injury
- Missed Lisfranc injury

## Prognosis

Most metatarsal fractures heal well with protected walking. Jones fractures and stress fractures with ongoing risk factors are prone to slow healing and recurrence.

## Prevention

- Gradual increase in training load
- Adequate energy intake, calcium and vitamin D
- Suitable footwear and rest days

## Test yourself

Think of the answer, then tap the question to see it.

## Which metatarsal is most often affected by a «march fracture»?

The second metatarsal, usually the shaft or neck, in recruits or runners after a rise in load.

## What separates a Jones fracture from a tuberosity avulsion of the fifth metatarsal?

An avulsion is at the tuberosity tip (zone 1); a Jones fracture is at the metaphysis–diaphysis junction (zone 2), where poor blood supply slows healing.

## Which tendon is classically blamed for avulsion of the fifth metatarsal base?

The fibularis (peroneus) brevis, with the lateral band of the plantar fascia, during an inversion injury.

## Why may the first X-ray be normal in a metatarsal stress fracture?

Early stress fractures show no line; MRI detects them, and callus appears on X-ray only after some weeks.

## Which clinical rule helps decide if foot X-rays are needed after injury?

The Ottawa foot rules: tenderness at the fifth metatarsal base or navicular, or inability to bear weight.

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## Related conditions

- [Medial tibial stress syndrome (shin splints)](https://durgical.com/en/conditions/medial-tibial-stress-syndrome/)
- [Lateral Ankle Sprain](https://durgical.com/en/conditions/lateral-ankle-sprain/)
- [Morton neuroma](https://durgical.com/en/conditions/morton-neuroma/)
- [Acute compartment syndrome](https://durgical.com/en/conditions/acute-compartment-syndrome/)
- [Osteoporosis](https://durgical.com/en/conditions/osteoporosis/)
- [Hallux valgus (bunion)](https://durgical.com/en/conditions/hallux-valgus/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Metatarsal Fractures](https://www.ncbi.nlm.nih.gov/books/NBK574512/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/metatarsal-fractures/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/metatarsal-fractures/