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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Metatarsal Stress Frx


- See: Forefoot and Midfoot Stress Frx

- Discussion:
    - march frx usually occurs in shaft of second or less often in the third metatarsal;
           - stress frx of 5th metatarsal represents a distinct fracture;
    - in runners stress frxs occur most often in metatarsal neck, while in dancers, stress frxs usually occur in proximal shaft;
    - in ballet dancers, frx occur at base of second metatarsal & Lisfranc's;
    - frx  results from stress of wt bearing after prolonged walking;
    - only rarely is there a history of direct trauma to the foot;
    - always consider whether osteoporosis or osteomalacia is present;

- Exam:
    - look for point tenderness over an area of induration or palpable mass;
    - note that cavus feet are a risk factor for stress frx;

- Radiographs:
    - frx callus is not seen until 3 weeks after the initial insult;
    - a hot lamp is useful to see the callus;
    - bone scans: are positive early;

     

- Treatment:
    - reduction of activity for 6 to 12 weeks, wooden soled shoe, or cast;
    - in rare cases in which stress frx occur with a cavus foot, plantar fascia release may be appropriate



Effect of varying arch height with and without the plantar fascia on the mechanical properties of the foot



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 22, 2012 12:34 pm