March fracture: Difference between revisions
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'''March fracture''', also known as '''fatigue fracture''' or '''stress fracture of metarsal bone''' is the [[fracture]] of distal third of one of the [[metatarsals]] |
'''March fracture''', also known as '''fatigue fracture''' or '''stress fracture of metarsal bone''' is the [[fracture]] of distal third of one of the [[metatarsals]] occurring because of recurrent overstress. It is more common in [[soldier]]s, but also occurs in hikers, and even those, like hospital nurses, whose duties entail much standing. It mostly occurs in [[second metatarsal]] of the right foot.<ref>Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery ISBN 0 7506 0625 8</ref> It is a common cause of foot pain, especially when people suddenly increase their acitivities.<ref>http://orthopedics.about.com/cs/lowerfx/g/march.htm</ref> |
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==Occurrence== |
==Occurrence== |
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[[Stress fracture]] can occur at many sites in the body, but particularly stress fracture |
[[Stress fracture]] can occur at many sites in the body, but particularly stress fracture occurring at metatarsal bones is called as march fracture. March fracture usually occurs in the shaft of second or less often in the [[third metatarsal bone]]; stress fracture of the [[fifth metatarsal]] is a distinct fracture (the [[Jones fracture]]). In runners, march fracture occurs most often in the metatarsal neck, while in dancers it occurs in proximal shaft. In ballet dancers, fracture mostly occurs at the base of [[second metatarsal]] and at [[Lisfranc joint]]s. This fracture always occurs following a prolonged stress or weight bearing, and the history of direct trauma is very rare. Consideration should always be given to [[osteoporosis]] and [[osteomalacia]]. [[Cavus]] feet are risk factor to march fracture.<ref>http://www.wheelessonline.com/ortho/metatarsal_stress_frx</ref> |
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==Clinical features== |
==Clinical features== |
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Revision as of 04:29, 1 January 2009
March fracture, also known as fatigue fracture or stress fracture of metarsal bone is the fracture of distal third of one of the metatarsals occurring because of recurrent overstress. It is more common in soldiers, but also occurs in hikers, and even those, like hospital nurses, whose duties entail much standing. It mostly occurs in second metatarsal of the right foot.[1] It is a common cause of foot pain, especially when people suddenly increase their acitivities.[2]
Occurrence
Stress fracture can occur at many sites in the body, but particularly stress fracture occurring at metatarsal bones is called as march fracture. March fracture usually occurs in the shaft of second or less often in the third metatarsal bone; stress fracture of the fifth metatarsal is a distinct fracture (the Jones fracture). In runners, march fracture occurs most often in the metatarsal neck, while in dancers it occurs in proximal shaft. In ballet dancers, fracture mostly occurs at the base of second metatarsal and at Lisfranc joints. This fracture always occurs following a prolonged stress or weight bearing, and the history of direct trauma is very rare. Consideration should always be given to osteoporosis and osteomalacia. Cavus feet are risk factor to march fracture.[3]
Clinical features
The onset is undramatic. When the boot or shoes are taken off, there is a cramplike pain in the affected forefoot, and moderate local edema appears on the dorsal aspect. On moving each toe in turn, that of the involved metatarsal causes pain, and when the bone is palpated from the dorsal surface, a point of tenderness is found directly over the lesion. Radiography at this stage is negative, but the condition is diagnosed correctly by military surgeons without the aid of x-rays. In civil life, it is seldom diagnosed correctly for a week or two, when, because of lack of immobilization, there is an excessive deposit of callus (which may be palpable) around the fracture. [4]
Diagnostic studies
X-ray is seldom helpful, but a CT scan and an MRI study may help in diagnosis.[5] Bone scan are positive in early. Dual energy X-ray absorptiometry is aslo helpful to rule out the comorbid osteoporosis. [6]
Differential diagnosis
- Acute metarsal fracture.
- Hallux rigidus.
- Jones fracture.
- Sesamoid stress fracture.
- Acute sesamoid fracture.
- Proximal fifth metatarsal avulsion fracture.[7]
Treatment
The first line treatment should be reduction of movements for 6 to 12 weeks. Wooden-soled shoes or a cast should be given for this purpose. In rare cases in which stress fracture occurs with a cavus foot, plantar fascia release may be appropriate. [8]
References
- ^ Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery ISBN 0 7506 0625 8
- ^ http://orthopedics.about.com/cs/lowerfx/g/march.htm
- ^ http://www.wheelessonline.com/ortho/metatarsal_stress_frx
- ^ Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery ISBN 0 7506 0625 8
- ^ Emergency Orthopedics: The Extremities By Robert Rutha Simon and Steven Koenigsknecht ISBN 0838522106
- ^ http://www.wheelessonline.com/ortho/metatarsal_stress_frx
- ^ http://emedicine.medscape.com/article/85746-diagnosis
- ^ http://www.wheelessonline.com/ortho/metatarsal_stress_frx