Forefoot Pain & Fractures

Forefoot Pain & Fractures

Forefoot pain often originates from the long metatarsal bones and pain under the ball of the foot. The more common forefoot fractures include metatarsal fracture, metatarsal stress fractures and Jones fracture. An acute fracture is caused by a direct impact such as dropping something on the foot, where repetitive impact causes a stress fracture.

Metatarsal fracture

This fracture is a break to one of the five long metatarsal bones in the foot and is usually caused by a direct trauma.


  • Acute and severe foot pain
  • Rapid foot swelling
  • Unable to weight bearing


  • Fractures can be diagnosis via X-ray. Although an X-ray will often not show the stress fractures.
  • If the bones are not displaced then a short cast will be fitted for the first three weeks. After six weeks the foot should be X-rayed again to ensure it has healed.
  • After some weeks according to specialist prescription, weight bearing activities can start by cast shoe.
  • More complex or displaced fractures may require surgical fixation.

Metatarsal stress fracture

A metatarsal stress fracture can occur through overuse or poor foot alignment. Stress fracture are usually involve the second, third or fourth metatarsal bones.

Cause of Stress fractures

  • More common in people with flat foot
  • People with over-supination
  • Over use in some activities without enough rest; such as runners, ballet dancers and gymnasts.
  • Common in army workers (march fracture)

Treatment of stress fractures

  • Often after two or three weeks, it has started to heal.
  • For those whose job requires long standing and weight bearing, a proper shoe or soft insole may be used.
  • Start gradual with a very slow return to activity.
  • If the stress fracture may have been caused by abnormal foot alignment such as overpronation or oversupination, using orthotics such as shoe inserts may be needed for correction of deformity.

Jones fracture

Jones’ fracture is a fracture of the 5th metatarsal bone on the lateral of the foot. Pain may be felt at the base of the 5th metatarsal.

Causes of Jones Fracture

  • Lateral ankle sprain (inversion stress).
  • Overuse; especially repetitive impact on the lateral side of foot.


  • Initial treatment starts wearing a cast for 6-8 weeks to immobilize the foot and prevent weight-bearing activity.
  • If the healing fails, surgery is recommended.
  • After removing cast, return to full training can be start by slow exercise and using ankle supportive devices.
  • For ankle sprains that apply extra stress to 5 metatarsi bone, using ankle braces is effective
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