What is the initial management for metatarsal stress fracture involving the second or third metatarsal?

What is the initial management for metatarsal stress fracture involving the second or third metatarsal?

• A. Immediate weight bearing
• B. Bed rest for 6 weeks
• C. Surgical pinning
• D. Non-weight bearing for a few days with posterior splint

Answer: (D)

The main idea is that metatarsal stress fractures heal best with protected immobilization and reduced loading early on. For fractures of the second or third metatarsal, starting with non-weight bearing for a short period while the bone begins to repair, using a posterior splint to immobilize and support the foot, minimizes bending forces at the fracture site and allows healing to begin without surgical intervention. This approach is preferred because bearing weight immediately can worsen the fracture or slow healing, and prolonged bed rest isn’t usually necessary. Surgical pinning is reserved for cases with displacement, instability, nonunion, or failure of nonoperative management, not for routine, non-displaced metatarsal stress fractures. After the initial immobilization, gradual reintroduction of weight bearing and activity is guided by symptoms and healing progress.

The main idea is that metatarsal stress fractures heal best with protected immobilization and reduced loading early on. For fractures of the second or third metatarsal, starting with non-weight bearing for a short period while the bone begins to repair, using a posterior splint to immobilize and support the foot, minimizes bending forces at the fracture site and allows healing to begin without surgical intervention.

This approach is preferred because bearing weight immediately can worsen the fracture or slow healing, and prolonged bed rest isn’t usually necessary. Surgical pinning is reserved for cases with displacement, instability, nonunion, or failure of nonoperative management, not for routine, non-displaced metatarsal stress fractures. After the initial immobilization, gradual reintroduction of weight bearing and activity is guided by symptoms and healing progress.