Metatarsal Bone Stress Stages and Injury Rehabilitation Exercises

Metatarsal bone stress injuries (BSI) are common overuse injuries which involve repetitive stress and force to the metatarsal affected, categorically resulting in pain. If you require further information regarding BSI’s, please read through this blog where you’ll gain a better understanding into the complex nature these injuries: What Is A Bone Stress Injury Or Stress Fracture?

Risk Factors:

The population that are at a higher risk in developing these injuries are people who have a Morton’s foot structure (second toe longer than first), forefoot runners, tight plantar flexor muscles (calves, bottoms of feet), reduced range of motion through the first big toe joint along with the typical BSI risk factors as per discussed in What Is A Bone Stress Injury Or Stress Fracture?

Stages:

Metatarsals one to five can be affected through bone stress however, 52% of metatarsal BSI’s are located within the second metatarsal and 35% in the third. Based on location within the metatarsal, this determines the severity of the injury. Metatarsal BSIs are split into three different zones. Zone one is classified as low risk whereas, zones two and three, are high risk. Pending the zone classification will guide the treatment plan.

Rehabilitation plan:

For low risk metatarsal BSI’s, a 12 week rehabilitation plan is required to ensure safety when returning into full participation. After the immobilisation period there are a key exercises to follow to maintain and rebuild strength. Whilst immobilising the affected metatarsal, it’s important to continue basic strength training with the opposite limb, to maintain strength and prevent atrophy. 

After four weeks, it’s recommended to work on foot intrinsic strength and first joint range of motion. This will help with the windlass mechanism through minimal load.

Weeks five to six is when the client will begin to wean out of the equipment immobilising the foot. During this process, the client can begin to increase load without putting too much force through the metatarsals. For example, leg press calf raise (focus on heel contact). This will eventually lead into a calf raise however, be guided per the practitioner’s assessments and patients testing. 

 A continuous progression of plantar flexor exercises will develop into functional exercises. Double and single leg hopping variants will be the final steps to return to full function given the practitioners advice.

For high risk metatarsal BSI’s, the treatment plan and exercise rehabilitation exercises are the exact same as the low risk BSI’s. The difference being, prior to commencing the plan, the client must be non-weightbearing for six to eight weeks and 11% of high risk cases, surgical intervention may be required.

If you need a hand with following a guided treatment plan post a metatarsal BSI, please don’t hesitate to make an appointment, we’d love to help!

Written by Cooper Garoni