Operative treatment of stress fractures of the proximal second metatarsal

Abstract

Proximal stress fractures of the second metatarsal are rare. They have been reported mainly in classical ballet dancers. Non-operative treatment has usually led to good results and rapid return to full activities. We present a series of nine cases with stress fractures of the proximal second metatarsal. The patients were all actively involved in sports. None of them were dancers. In all of these patients non-operative treatment lasting for an average of 13 months had failed. All of the patients were operated on using the same method. In the operation drilling was performed around and through the fracture line. The patients were followed for an average of 38 months. All except one of the patients were able to return to their prior level of activity within 4-6 months. In conclusion if non-operative treatment fails surgery seems to give good results in most patients with a stress fracture of the proximal second metatarsal.

Stress Fractures about the Foot and Ankle in Athletes

“…They are common injuries in runners, military recruits, ballet dancers, and basketball players, and most patients will report a recent increase in training. [1][2][3][4][5][6][7][8]10,13,20,22,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Forefoot pain with weight bearing, inability to toe walk, point tenderness, and swelling are present on exam. [1][2][3][4][5][6][7][8]10,13,20,22,[41][42][43][44][45][46][47][48]…”

“…4) can differentiate between stress reaction or fracture and soft tissue abnormalities, and CT scan can show cortical irregularities, if present. 2,8,56 Distal second metatarsal stress fractures are cited as the most common among metatarsal stress fractures, and possibly among all stress fractures. 22 During walking and running, the second and third metatarsals see the highest bending strain and shear force.…”

“…41,43 The insidious onset of vague midfoot pain is often overlooked or misdiagnosed. 41,43,49,[51][52][53]56 The second and third metatarsals are most affected.…”

“…They are at risk during ballet in the 'en pointe' position due to the locking of the second metatarsal base and cuneiforms in extreme plantar flexion. 41,43,49,[51][52][53]56 Intrinsic risk factors include a pronated foot and poor ankle plantarflexion causing a so-called 'over-pointe' foot with compensatory plantarflexion through the Lisfranc joint. 41 This causes the center of gravity to be anterior to the metatarsal shaft, creating more force at the base.…”

Atypical Stress-Avulsion Fracture of the Lisfranc Joint Complex

“…6 Stress fracture of the Lisfranc joint is uncommon but has been described predominantly in ballet dancers. [7][8][9][10] We present a case of an avulsion type stress fracture involving the TMT joint complex in a 46-year-old female patient. This fracture differs from previous reports in that the patient was not involved in any form of sporting activity.…”