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March fracture
Fracture of the metatarsal bones of the foot due to recurrent stress
Fracture of the metatarsal bones of the foot due to recurrent stress
| Field | Value |
|---|---|
| name | March fracture |
| synonyms | Fatigue fracture or Stress fracture of metatarsal bone |
| image | File:Stress fracture of the second metatarsal bone1.jpg |
| caption | Stress fracture of the second metatarsal bone |
| field | orthopedic |
March fracture is the fracture of the distal third of one of the metatarsal bones occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and other people whose duties entail much standing (such as hospital doctors). March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.
Signs and symptoms
The onset is not dramatic. When the boot or shoes are taken off, there is a cramp-like 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.
Diagnosis
X-ray is seldom helpful, but a CT scan and an MRI study may help in diagnosis. Bone scans are positive early on. Dual energy X-ray absorptiometry is also helpful to rule out comorbid osteoporosis.
Differential diagnosis
- Acute metatarsal fracture
- Hallux rigidus
- Jones fracture
- Sesamoid stress fracture
- Acute sesamoid fracture
- Proximal fifth metatarsal avulsion fracture
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.
Occurrence
Stress fractures can occur at many sites in the body; "march fracture" simply refers to a stress fracture specifically of the metatarsals, so named because the injury is sometimes sustained by soldiers during sustained periods of marching.
References
References
- Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery {{ISBN. 0 7506 0625 8{{Page needed. (February 2011)
- "Metatarsal Fractures". www.patient.co.uk.
- Collier, Judith. (2009). "Oxford Handbook of Clinical Specialities". Oxford University Press.
- "The 3 Types of Fifth Metatarsal Fractures".
- Emergency Orthopedics: The Extremities By Robert Rutha Simon and Steven Koenigsknecht {{ISBN. 0838522106{{Page needed. (February 2011)
- {{EMedicine. article. 85746. Metatarsal Stress Fracture
- (22 July 2020). "Metatarsal Stress FRX".
- "Best Shoes for Lisfranc Injury".
This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.
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