Stress Fracture – 4th Metatarsal

One Patients Story to Treatment and Recovery

““After falling and fracturing my leg, I was only able to bear 50 pounds of weight through my leg. I was scared at first, but it was amazing; I felt like I was floating on air. I couldn’t believe I was walking and not in pain. The AlterG is definitely helping me reach my rehabilitation goals. Next week, I can start to bear more weight and the AlterG will really help me add weight slowly and safely as I continue to regain strength. I can see myself walking the way I used to.””

Sandra Jaquis, Patient, Southlake Village Rehabilitation and Care Center

One Patients Recovery from a 4th Metatarsal Stress Fracture

Karen Shuler, PT, DPT


24 y/o female Field Hockey player with healed Plantar fascia tear, sesamoid fx and entrapped nerve. Sport is played on artificial turf, requires constant running and frequent change of direction.

  • Athlete suffered from acute foot pain after activity. Diagnostic imaging confirmed diagnosis of a 4th Metatarsal Stress Fracture.
  • Athlete followed physician’s recommendations for initial care and 4th Metatarsal Stress Fracture treatment.

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  • Following release to weight-bearing, incorporate de-weighting into rehabilitation protocol
  • Develop a progressive return to activity
  • Maintain fitness and function during rehabilitation

History / Progression

I. Plan

  • Athlete was diagnosed with with a 4th Metatarsal Stress Fracture
  • Upon consultation with treating physician and review of diagnostic imaging the athlete was placed in a walking boot for 4 weeks, WBAT
  • After physician release to unrestricted weight bearing, a complementary conditioning program was developed incorporating the AlterG Anti-Gravity Treadmill®
  • Along with traditional medical treatment: modalities, therapeutic exercise, joint mobilization and NSAID’s, the AlterG Anti-Gravity Treadmill® was added to the treatment protocol
  • Program duration was for 8 weeks
  • AlterG Anti-Gravity Treadmill® was incorporated at week 5 of rehabilitation once athlete was cleared for unrestricted weight bearing
  • Athlete achieved desired competition goals

II. Considerations

  • Pain/ soreness levels were considered and used to gauge weight percentage and speed. Pain level reported by athlete was not to exceed 4 on a scale of 1-10 during Phase I, and not to exceed 3 on a scale of 1-10 during Phases II-IV
  • Athlete feedback was considered prior to each workout
  • Pre and post workout pain was recorded and monitored

III. Progression

Download Case Study to see Table 1 and Table 2.


The athlete was released for return to sport by the treating physician after 8 weeks of physical therapy exercises. The athlete achieved the goals of the rehabilitation plan, incorporating a progressive sport specific conditioning plan to transition the athlete to full partici- pation. The AlterG Anti-Gravity Treadmill® was incorporated into the athlete’s rehabilitation plan to establish confidence, maintain fitness, manage gait and progressively increase impact on the extremity.

The athlete resumed modified activity after release from rehabilitation and continued using the AlterG Anti-Gravity Treadmill® (physical therapy equipment) as part of the reconditioning program.