- 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.