A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management.

Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.