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metararsal stress fracture (march fracture)
Etiology:
- rheumatoid arthritis predisposes
- osteoporosis predisposes
Epidemiology:
- athletes, performers & others participating in high-impact activities
- common site of stress fracture
Pathology:
- most common on 2nd & 3rd metatarsal bones as these are relatively fixed in the foot & sustain the greatest impact
- 5th metatarsal less common
Clinical manifestations:
- initially, dull pain only with exercise
- may progress to pain at rest
- pain starts diffusely, then localizes to site of fracture
Laboratory:
- consider rule/out rheumatoid athritis
- erythrocyte sedimentation rate & serum CRP
- rheumatoid factor
Radiology:
- X-ray of foot
- radiographs may be negative early in the process
- stress-fracture changes may not be evident on plain films until 3 months after the onset of symptoms
- up to 50% of stress fractures are never observed on plain films
- MRI is the imaging modality of choice
- same sensitivity & better specificity than bone scan
- bone scan
- technetium-99 (99m Tc) diphosphonate 3-phase bone scanning formerly the imaging modality of choice
- nearly 100% sensitive for diagnosis of stress fractures; specificity is considerably lower
- bone scans can demonstrate stress fractures within 24-72 hours from the onset of symptoms
- ultrasound
Differential diagnosis:
- Morton neuroma
- metatarsalgia
- turf toe
Management:
- rest from offending activity
- immobilization with orthopedic cast
- surgery rarely required
- orthopedic consult for 5th metatarsal fractures or for 2nd or 3rd metatarsal fractures that do not heal after 6 weeks
Related
metatarsal bone
General
stress fracture (fatigue fracture)
References
- Perron AD and Ho SSW
Metatarsal Stress Fracture
http://emedicine.medscape.com/article/85746-overview