A lot of people are getting back into running or training for a marathon at the moment. So we thought it would be good to explain a common running injury and the best way to look after it to be able to keep training.

Metatarsal Stress Fracture

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What is it?

A stress fracture is an over use injury, common at the metatarsal bones in the foot, navicular bone and the tibia. Less common sites are around the hip, pelvis, sacrum and lumbar spine. A stress fracture is developed following repeated movements that stress the bone, causing micro trauma from sub maximal loading. The appearance of a stress fracture brings pain on movement, which increases as the movement is repeated, but eases with rest.

The pain is characterised as being very local (pain when the bone is touched). There would be little to no pain until you have hit the site of the stress fracture. The metatarsals are prone to stress fractures in runners, due to the forces places through this area.


Early warning signs

– Pain on activity, at a specific site within the foot, usually over one or two metatarsals.

– Symptoms ease with rest.

– Pain doesn’t go away as activity increase, and, if anything, gets worse.

– The area may also be swollen.


Common reasons for injury

– Poor biomechanics

– Weak glutes (bum muscles)

– Poor foot posture

– Badly fitting footwear

– Poor running technique

– Those who increase training too quickly

– Those who try the transition from normal footwear to minimalist footwear inappropriately

– Vitamin D deficiency

– Females that train too hard as a consequence do not menstruate

– Post-menopausal women


Progression of the injury

Usually pain will limit you doing any further damage. However, for those who continue, the pain will eventually get worse at the site and this pain will spread making the injury worse, prolonging your healing time.


Self Assessment

Run your hand over the foot until you feel an area that is clearly in the most pain. Press firmly about three inches away from the area of pain, onto the same bone.  Gradually press along the bone getting closer to the site of pain. If you feel little or no pain until you are directly over the injury site, or only slightly past it, but immense pain directly over the injury, this is typical of a stress fracture.



Rest is key for this injury! In the worst cases you may have to wear an aircast boot to protect the foot for 6 weeks. Physiotherapists can usually diagnose this injury effectively. Stress fractures are only visible when they start to heal as you can see the bone that is lead down for healing (callus) around the fracture site. Therefore, X-rays should be taken at least four weeks after the onset of symptoms otherwise the fracture might not show up.


What to expect from a Physiotherapist

The practitioner will listen to your story as this usually provides all the clues needed to make a diagnosis. They will then carry out an assessment of the foot. This includes, assessing range of motion, strength tests, and applying pressure to the metatarsal bones in your feet, looking for points of pain.

Leading on from the diagnosis a plan will be formulated. Usually this includes a six week rest period, but that doesn’t mean you can drop straight back into running at the end of the six weeks. An exercise program to keep up some lower limb conditioning to assist the smooth return to running is highly recommended.


Here at Comfort Health

If you are struggling with any foot pain when running. Please stop. It’s really important to get your area of pain checked out by a specialist. At Comfort Health we can diagnose your injury, but also help with reducing your pain, allowing for a speedy recovery. Click HERE to get an appointment with one of our practitioners!