Health condition · Clinically reviewed
Metatarsal stress fracture, the classic march fracture — MRI diagnosis and structured return to running.
Stress fracture of a metatarsal shaft — classically the second or third — from repetitive loading. The classic “march fracture”. Modern stratified care: offloading, bone-health work-up and graded return; internal fixation for the high-risk Jones fracture pattern.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against BOFAS, NICE and BASEM sources you can see at the end.
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Current for 2026
Reflects current UK guidance on stress-fracture management, RED-S screening and return-to-run programmes.
Key facts
Metatarsal stress fracture at a glance.
The essentials, in plain English — what a stress fracture is, why X-rays miss it early, and what actually gets you back running safely.
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Definition
A fatigue or insufficiency fracture of a metatarsal shaft — micro-damage from repetitive loading that outpaces bone remodelling.
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Most common sites
The second and third metatarsals are most commonly affected — the classic "march fracture" of the marching soldier or new runner.
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High-risk Jones
The Jones fracture of the fifth metatarsal has its own guide — it is higher risk for non-union and often needs surgical fixation.
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MRI is key
MRI is the investigation of choice — X-ray is often normal for the first 2–3 weeks before callus appears.
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Load errors matter
Almost every case has a training-load error behind it — a sudden mileage jump, new terrain or new footwear.
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Screen for RED-S
Nutritional and hormonal review is essential — low energy availability drives recurrent stress fractures in runners and dancers.
Why this guide matters
Image early, address the driver.
Most metatarsal stress fractures heal quickly if diagnosed early — and recur reliably if the training-load and bone-health drivers are ignored.
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A normal X-ray does not rule it out
X-ray is often normal for the first 2–3 weeks — MRI is the investigation of choice for early diagnosis.
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Training load is the real driver
Almost every case has a mileage jump or footwear change behind it — fix that and you fix the fracture.
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Screen every athlete for RED-S
Low energy availability, low vitamin D and low bone density drive recurrent fractures — a proper screen is essential.
How the diagnosis is made
From painful forefoot to a clear plan.
The steps a UK GP or sports doctor will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History, examination and first-line X-ray
Phase 2 · Confirming
MRI foot and ultrasound for callus
Phase 3 · Managing
Bone health and RED-S review
- 01
Recognising
Training and footwear history
Mileage jumps, new terrain, new shoes and a sudden change in surface — the story usually points straight to the diagnosis.
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Recognising
Focal metatarsal palpation
Pinpoint tenderness over a single metatarsal shaft, sometimes with a palpable lump of early callus.
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Recognising
Weight-bearing X-ray
First-line imaging — often normal in the first 2–3 weeks, so a negative X-ray does not exclude a stress fracture.
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Confirming
MRI foot for early diagnosis
The investigation of choice — picks up bone oedema well before any cortical break is visible on X-ray.
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Confirming
Ultrasound for later callus
Useful in later, healing cases to visualise periosteal callus and confirm the fracture site.
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Managing
Bone density (repeated fractures)
DEXA and bone-health work-up for anyone with a second stress fracture or risk factors for low bone density.
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Managing
Nutritional and hormonal review
RED-S screen — energy availability, menstrual history, vitamin D, calcium and thyroid — done properly, not as a tick-box.
Typical timeline: 2–3 weeks from first appointment to imaging and a settled plan.
Symptoms
What a metatarsal stress fracture actually feels like.
The pattern is more telling than any single symptom — sharp pain over one metatarsal, worse with impact, better with rest, in someone who has recently ramped up training.
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Midfoot / forefoot pain
A deep, localised ache across the front of the foot — worse with weight-bearing, easier at rest.
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Pain on impact / running
Sharp pain each time the forefoot loads — the moment of push-off in running or brisk walking.
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Local swelling
Swelling over a single metatarsal shaft, sometimes with a small palpable lump of healing callus.
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Recurrent symptoms
A history of pain that comes and goes with running mileage — often ignored until it stops resolving.
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Improved with rest
Classic pattern — better with a few days off, worse again on return to running or long walks.
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Sudden training load spike
A mileage jump, new terrain, new shoes or a return to running after time off — almost always in the story.
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Point tenderness on MT shaft
Pinpoint tenderness over one metatarsal shaft on examination — often the most useful single sign.
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Red flag
5th metatarsal (Jones) or navicular stress fracture — high non-union risk, needs urgent surgical opinion.
Treatment
How metatarsal stress fractures are treated in the UK.
A stratified approach — offloading and load-error correction for most, structured return-to-run rehab, and early screw fixation for the high-risk Jones pattern.
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Non-weight-bearing / stiff-soled shoe 4–6 weeks
Offloading the fracture site for 4–6 weeks in a stiff-soled shoe is enough for most low-risk metatarsal shaft fractures.
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Boot immobilisation
A walking boot for more painful or higher-risk cases — protects the fracture while you keep gently mobile.
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Address training-load errors
The most important intervention — identify the mileage jump, terrain change or footwear change that caused it.
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Nutrition, vitamin D and calcium
Correct energy intake, protein, vitamin D and calcium — the raw materials the healing bone actually needs.
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Physiotherapy graded return
A structured return-to-run plan — walk, walk-run, easy run, then load — over weeks, not days.
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Gait analysis and cushioned shoe
A specialist gait review and a properly cushioned running shoe reduces the risk of a second stress fracture.
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Bone stimulator (specialist)
Low-intensity pulsed ultrasound or a bone stimulator, in specialist hands, for slow-healing cases.
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Intramedullary screw fixation (Jones only)
Reserved for the high-risk Jones fracture of the fifth metatarsal — early screw fixation gets athletes back faster.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, sports doctor or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Orthopaedic Foot and Ankle Society (BOFAS). Clinical standards and patient information.
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NICE. MSK guidance on stress fractures and lower-limb overuse injuries.
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British Association of Sport and Exercise Medicine (BASEM). Return-to-sport guidance.
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IOC consensus statement on Relative Energy Deficiency in Sport (RED-S).
Red flags
When foot pain is not just a routine stress fracture.
Most metatarsal stress fractures heal well with offloading. These are the situations where a different diagnosis, higher-risk pattern or underlying driver needs urgent attention.
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Jones fracture (5th metatarsal)
A fracture at the base of the fifth metatarsal — high non-union risk, needs urgent orthopaedic opinion and usually surgery in athletes.
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Navicular stress fracture
Deep midfoot pain with tenderness over the "N spot" — high non-union risk, needs MRI and specialist review.
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Displaced metatarsal fracture
Any displaced or acute traumatic fracture needs orthopaedic assessment — not a stress-fracture pathway.
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RED-S
Low energy availability with menstrual disturbance or recurrent bone injury — needs a proper multidisciplinary review.
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Osteoporotic insufficiency
Stress fracture in an older adult without significant training load — investigate underlying osteoporosis.
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Bilateral stress fractures
Bilateral or multiple stress fractures — screen hard for bone health, nutrition and endocrine causes.
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Post-op wound complication
Increasing pain, redness, swelling or fever after Jones fracture fixation — contact your surgical team same day.
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Refracture
A second fracture at the same site after apparent healing — imaging and specialist review before returning to load.
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Failed return-to-run
Pain that returns with each attempt to build mileage — needs re-imaging and a proper look for an underlying driver.
Living with it
A quick condition to heal, but easy to re-fracture.
Four things that make the biggest difference — respect the window, fuel the bone, walk before you run, and re-image if pain returns.
A quiet reminder
Patience now saves months later.
A missed week early is nothing. A refracture from returning too soon is months.
- 01 Load
Respect the healing window
Four to six weeks of protected loading — pushing back to running early is the single most common cause of a second fracture.
- 02 Fuel
Fuel your bones
Energy availability, protein, vitamin D and calcium — the raw materials the bone needs to heal properly.
- 03 Return
Walk before you run
Structured walk, walk-run then easy-run programme — build mileage back slowly, no more than 10% a week.
- 04 Reviews
Re-image if pain returns
Any return of point tenderness on return to running warrants a repeat scan — do not push through.
Frequently asked
Everything we get asked about metatarsal stress fractures.
Quick answers on imaging, healing time, Jones fractures, RED-S and safe return to running.
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What actually causes a metatarsal stress fracture?
Repetitive loading that outpaces the bone’s ability to remodel — almost always a training-load error such as a sudden mileage jump, new terrain, new shoes or a return to running after time off. Low energy availability, low vitamin D and low bone density all make it more likely.
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How long does it take to heal?
Most low-risk metatarsal shaft stress fractures heal in 4–6 weeks of protected loading, followed by a graded return-to-run programme over another 4–6 weeks. Jones (5th metatarsal) and navicular stress fractures are higher risk and take longer.
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Do I need a scan?
Yes — X-ray first, but a normal X-ray in the first 2–3 weeks does not rule anything out. MRI is the investigation of choice for early diagnosis, and ultrasound is useful later on to visualise healing callus.
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What is a Jones fracture and why does it matter?
A Jones fracture is a specific fracture at the base of the fifth metatarsal — it sits in a poor blood-supply watershed area and has a high non-union rate. In athletes it is often fixed early with an intramedullary screw. It has its own patient guide.
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What is RED-S and why keep mentioning it?
Relative Energy Deficiency in Sport — when energy intake does not match training demand. It reduces bone density, disrupts menstrual and hormonal function and drives recurrent stress fractures. Any runner or dancer with a stress fracture deserves a proper screen for it.
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When can I go back to running?
When you are pain-free walking, pain-free on impact loading and cleared by your clinician — usually 6–10 weeks in total for a straightforward metatarsal shaft fracture. Then a structured walk-run programme, building mileage by no more than 10% a week.
Related content
Keep reading.
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Jones fracture
The high-risk fifth metatarsal fracture — a separate guide.
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Metatarsalgia
Forefoot pain without a stress fracture.
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Foot MRI
The investigation of choice for early stress fractures.
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All conditions
The full A–Z of our patient guides.
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Musculoskeletal MRI
Related diagnostic test.
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X Ray
Related diagnostic test.
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Cortisone Shots
Related treatment option.
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Chondroplasty
Related treatment option.
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