Fifth metatarsal stress fracture

NewsBot · Mar 17, 2010

Members do not see these Ads. Sign Up.
Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture.
Hetsroni I, Nyska M, Ben-Sira D, Mann G, Segal O, Maoz G, Ayalon M.
Foot Ankle Int. 2010 Mar;31(3):203-11.

BACKGROUND: In the past, several studies provided anecdotal descriptions of high-arched feet in individuals sustaining proximal fifth metatarsal stress fractures. This relationship has never been supported by scientific evidence. Our objective was to examine whether athletes who sustained this injury had an exceptional static foot structure or dynamic loading pattern. MATERIALS AND

METHODS: Ten injured professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation. Each variable was compared between injured, contra-lateral uninjured, and control feet.

RESULTS: Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation revealed relative unloading of the fourth metatarsal in injured and uninjured limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes.

CONCLUSION: Athletes who sustained proximal fifth metatarsal stress fracture were not characterized by an exceptional static foot structure. Dynamically, lateral metatarsal unloading during stance may either play a role in the pathogenesis of the injury, or alternately represent an adaptive process.

CLINICAL RELEVANCE: Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics
Click to expand...

Admin2 · Mar 17, 2010

Related threads:
Other threads tagged with stress fractures
Fractured base of 5th or Os vesalianum pedis

NewsBot · Feb 5, 2011

Surgical results of 5th metatarsal stress fracture using modified tension band wiring.
Lee KT, Park YU, Young KW, Kim JS, Kim JB.
Knee Surg Sports Traumatol Arthrosc. 2011 Feb 3. [Epub ahead of print]

PURPOSE: The purpose of this study was to evaluate the surgical results of modified tension band wiring using two cortical screws for the treatment of fifth metatarsal stress fractures.

METHODS: Forty-two patients with Torg's type I and II fifth metatarsal stress fractures treated using the modified tension band wiring technique from 2005 to 2008 were evaluated retrospectively. All of the patients were elite athletes.

RESULTS: The mean length of follow-up was 26 ± 16 months (12-62 months). All patients were able to return to their previous levels of sporting activity. The mean time to union as determined by CT was 75 ± 25 days (40-150 days). However, during follow-up, there were 4 delayed unions, 1 nonunion, and 4 refractures.

CONCLUSION: The described modified tension band wiring technique is a good alternative method for the surgical treatment of Torg's type I and II fifth metatarsal stress fractures.

LEVEL OF EVIDENCE: Case series with no comparison group, retrospective case series, Level IV.
Click to expand...

NewsBot · Oct 19, 2011

The Plantar Gap: Another Prognostic Factor for Fifth Metatarsal Stress Fracture
Kyung Tai Lee et al
Am J Sports Med October 2011 vol. 39 no. 10 2206-2211

Background: There have been diverse results, even in the same Torg type classification, in cases with fifth metatarsal stress fracture.

Hypothesis: The “plantar gap” is correlated with the time for bone union and complications. It might be used for a prognostic factor.

Study Design: Cohort study; Level of evidence, 3.

Methods: Seventy-five cases with a fifth metatarsal stress fracture treated with modified tension band wiring from January 2003 to December 2008 were evaluated retrospectively. This consecutive series of patients included 71 male and 2 female patients with a mean of 19.8 years of age at the time of surgery. All of the enrolled patients were elite-level athletes. Each case was classified according to Torg classification and the degree of plantar gap was also measured. After the surgery, bone union was determined by computed tomography findings. Statistical analysis of the Torg classification and time for bone union, as well as plantar gap and time for bone union, was performed.

Results: The mean time for bone union for each Torg type was 71.05 ± 21.77 days for type I, 104.48 ± 54.62 days for type II, and 122.92 ± 51.75 days for type III. There was a significant difference in the time for bone union among the 3 Torg types (P = .008). The mean time for bone union in group A (plantar gap <1 mm) was 71.21 ± 29.95 days and it was 126.4 ± 51.99 days for group B (plantar gap ≥1 mm) (significantly different; P < .001). In addition, there was a positive correlation of the time for bone union with the degree of plantar gap (ρ = .661, P < .001). In cases with Torg type II classification, there was a significant difference in the time for bone union between groups A and B (P < .001) In addition, there was a strong correlation between the time for bone union and the degree of plantar gap (ρ = .657, P < .001). There were 8 cases of nonunion in Torg type II, and 1 case in Torg III. With regard to the plantar gap, there was 1 case of nonunion in group A, and 8 cases in group B.

Conclusion: The results of this study suggest that the plantar gap might be used for prognosis in cases with a fifth metatarsal stress fracture, even in patients with the same Torg classification.
Click to expand...

NewsBot · Nov 7, 2011

Radiographic evaluation of foot structure following fifth metatarsal stress fracture.
Lee KT, Kim KC, Park YU, Kim TW, Lee YK.
Foot Ankle Int. 2011 Aug;32(8):796-801.

BACKGROUND:
Correlation between foot structure and stress fracture risk has not been adequately evaluated or proven. The purpose of this study was to compare foot structure in fracture cases versus control with respect to radiological parameters in stress fractures of the fifth metatarsal.

MATERIALS AND METHODS:
The study group consisted of 50 consecutive athletes with a diagnosis of fifth metatarsal stress fracture and a control group matched for sport type and age. Fifth metatarsophalangeal (MTP-5) angle, fourth-fifth intermetatarsal (IMA4-5) angle, fifth metatarsal lateral deviation (MT5-LD) angle were measured on standing antero-posterior (AP) radiographs. Talo first metatarsal (T-MT1) angle, talo-calcaneal (TC) angle, and calcaneal pitch (CP) angle were measured on a standing lateral view, and MT5-LD angle was measured on a 30-degree medial oblique view.

RESULTS:
Significant inter-group differences were found for TC angle (p < 0.001) and calcaneal pitch angle (p < 0.001) on lateral radiographs, and for IMA4-5 angle (p = 0.003), MT5-LD angle (p = 0.002) on AP radiographs, and for MT5-LD angle (p < 0.001) on the 30-degree medial oblique radiographs.

CONCLUSION:
Fifth metatarsal stress fractures were found to be associated with elevated T-MT1 angle and CP angle representing a cavus foot and the increased curvature of fifth metatarsal. In addition, the extent of fifth metatarsal curvature on a 30-degree medial oblique view was found to be more related to the risk of fracture than on the AP view.
Click to expand...

NewsBot · Feb 8, 2013

Prognostic Classification of Fifth Metatarsal Stress Fracture Using Plantar Gap
Kyung Tai Lee, Young Uk Park, Hyuk Jegal, Jong Won Park, Jung Pil Choi, Jin Su Kim,
Foot & Ankle International February 4, 2013

Background: There have been diverse results even in same Torg type of fifth metatarsal stress fractures.

Methods: Eighty-six cases with a fifth metatarsal stress fracture that were treated with modified tension band wiring from January 2003 to May 2009 were evaluated retrospectively. Each case was classified according to Torg’s classification and a new classification. Using the new proposed classification, cases were subdivided into complete fracture and incomplete fracture. The cases of incomplete fracture were subdivided based on presence or absence of plantar gap more than 1 mm. After surgery, bone union was determined by CT. Statistical analysis of the Torg classification and time for bone union as well as the proposed new classification and time for bone union was performed.

Results: There was a significant difference in the time for bone union among the three Torg types (P = 0.004). The mean time for bone union in group A (complete fracture, n = 32) was 67.5 ± 28.8, and it was 103.2 ± 47.7 for group B (incomplete fracture, n = 54). There was a significant difference in time for bone union between them (P < 0.001). The mean time for bone union in group B1 (incomplete fracture, plantar gap less than 1 mm, n = 16) was 73.9 ± 26.7, and it was 115.5 ± 45.4 for group B2 (incomplete fracture, plantar gap 1 mm or more, n = 38). There was a significant difference in time for bone union between them (P < 0.001).

Conclusion: The results of this study suggest that the classification incorporating the plantar gap might be used for classification of fifth metatarsal stress fractures.
Click to expand...

NewsBot · Nov 10, 2013

Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture
Patrick J. Battaglia, Martha A. Kaeser, Norman W. Kettner
Journal of Chiropractic Medicine; Available online 4 November 2013

Objective
The purpose of this report is to describe a fifth metatarsal stress fracture that was not detectable using conventional radiographs and was identified with diagnostic ultrasonography (US), confirmed with computed tomography, and followed through symptom resolution with US.

Clinical features
A 68-year-old woman presented to a chiropractic teaching clinic for evaluation of right foot pain. Diagnostic US examination using an 8- to 15-MHz linear array transducer showed increased vascularity, periosteal elevation, and cortical disruption of the proximal diaphysis of the fifth metatarsal suggestive of a stress fracture. The patient was referred to an orthopedic specialist for comanagement.

Intervention and outcome
The patient was treated by an orthopedist who confirmed a stress fracture using computed tomography, and she was fit with a short-leg walking boot. Serial US images were obtained to document fracture healing and exclude complications. After 6 months, the patient was asymptomatic and had resumed all of her daily activities.

Conclusion
We report a case of a proximal fifth metatarsal stress fracture that was visualized with US and followed through symptom resolution by serial examinations.
Click to expand...

NewsBot · Nov 13, 2013

Factors Associated With Recurrent Fifth Metatarsal Stress Fracture.
Lee KT, Park YU, Jegal H, Kim KC, Young KW, Kim JS.
Foot Ankle Int. 2013 Nov 11

BACKGROUND:
Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution.
METHODS:
The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities.
RESULTS:
Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo-first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial oblique radiographs were significantly greater in the refracture group. For B2 cases (incomplete fracture and a plantar gap of 1 mm or larger), mean weight (P = .046), IMA4-5 angle on AP radiographs (P = .019), and MT5-LD angle (P = .045) on 30-degree medial oblique radiographs were significantly greater in the refracture group. All cases of refracture had a traumatic history after bone union. Refracture developed within 6 months of starting rehabilitation in 13 cases and within 3 months in 8 cases.
CONCLUSION:
The development of refracture after the surgical treatment of fifth metatarsal stress fractures was found to be associated with higher body mass index (BMI) and with radiological parameters (IMA4-5 on AP radiographs, MT5-LD on oblique radiographs) associated with protrusion of the fifth metatarsal head. The study indicates that patients with a protruding fifth metatarsal head and a high BMI should approach rehabilitation with care before considering a return to previous sporting activity levels.
Click to expand...

NewsBot · Aug 22, 2015

The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial
Hanneke Weel, Wouter H. Mallee, C. Niek van Dijk, Leendert Blankevoort, Simon Goedegebuure, J. Carel Goslings, John G. Kennedy and Gino M. M. J. Kerkhoffs
BMC Musculoskeletal Disorders 2015, 16:211 doi:10.1186/s12891-015-0649-4

Background
Fifth metatarsal (MT-V) stress fractures often exhibit delayed union and are high-risk fractures for non-union. Surgical treatment, currently considered as the gold standard, does not give optimal results, with a mean time to fracture union of 12-18 weeks. In recent studies, the use of bone marrow cells has been introduced to accelerate healing of fractures with union problems. The aim of this randomized trial is to determine if operative treatment of MT-V stress fractures with use of concentrated blood and bone marrow aspirate (cB + cBMA) is more effective than surgery alone. We hypothesize that using cB + cBMA in the operative treatment of MT-V stress fractures will lead to an earlier fracture union.

Methods/Design
A prospective, double-blind, randomized controlled trial (RCT) will be conducted in an academic medical center in the Netherlands. Ethics approval is received. 50 patients will be randomized to either operative treatment with cB + cBMA, harvested from the iliac crest, or operative treatment without cB + cBMA but with a sham-treatment of the iliac crest. The fracture fixation is the same in both groups, as is the post-operative care.. Follow up will be one year. The primary outcome measure is time to union in weeks on X-ray. Secondary outcome measures are time to resumption of work and sports, functional outcomes (SF-36, FAOS, FAAM), complication rate, composition of osteoprogenitors in cB + cBMA and cost-effectiveness. Furthermore, a bone biopsy is taken from every stress fracture and analysed histologically to determine the stage of the stress fracture. The difference in primary endpoint between the two groups is analysed using student’s t-test or equivalent.

Discussion
This trial will likely provide level-I evidence on the effectiveness of cB + cBMA in the operative treatment of MT-V stress fractures.
Click to expand...

NewsBot · Nov 24, 2015

Evaluating the Risk of a Fifth Metatarsal Stress Fracture by Measuring the Serum 25-Hydroxyvitamin D Levels
Yu Shimasaki et al
Foot & Ankle International November 23, 2015

Background: The fifth metatarsal bone is a common site of stress fractures in soccer athletes. Although several endocrine risk factors for stress fractures have been proposed, the endocrine risks for fifth metatarsal (5-MT) stress fractures have not been evaluated.
Methods: To evaluate the endocrine risks of fifth metatarsal stress fractures, we conducted a cumulative case-control study. The present study included 37 athletes, of which 18 had a history of a zone 2 or zone 3 fifth metatarsal stress fracture and 19 controls. We analyzed serum 25-hydroxyvitamin D (25-OHD), serum parathyroid hormone (PTH), as well as biochemical markers of bone turnover by univariate or multivariate analyses.
Results: Logistic regression analyses adjusted for multiple confounders revealed that insufficient serum 25-OHD levels less than 30 ng/mL (odds ratio [OR], 23.3), higher serum PTH levels (OR, 1.01), or higher serum bone-specific isoform of alkaline phosphatase levels (OR, 1.10) rather than serum tartrate-resistant acid phosphatase 5b were associated with statistically significantly increased odds of 5-MT stress fractures. A postestimation calculation demonstrated that 25-OHD levels of 10 and 20 ng/mL were associated with 5.1 and 2.9 times greater odds for 5-MT stress fractures, respectively.
Conclusion: 25-OHD insufficiency was associated with an increased incidence of 5-MT stress fractures. This insight may be useful for intervening to prevent 5-MT stress fractures.
Click to expand...

NewsBot · Apr 6, 2016

Rare Proximal Diaphyseal Stress Fractures of the Fifth Metatarsal Associated With Metatarsus Adductus
Kyle E. Wamelink, DPM, John T. Marcoux, DPM, FACFAS, Scott M. Walrath, DPM
JFAS; Article in Press

Before the report of English surgeon Robert Jones, who sustained a fracture to his fifth metatarsal while dancing around a tent pole, metatarsal fractures were thought to be the result of direct trauma to the foot. The mechanism of metatarsal fractures, in particular, those involving the fifth metatarsal, is now well understood. Patients with an adducted alignment of their forefoot can overload the fifth metatarsal base, putting them at an increased risk of fractures of this bone. Studies have reported that 2 distinct types of proximal diaphyseal or junctional fractures of the fifth metatarsal occur: the acute proximal diaphyseal or transverse proximal diaphyseal fracture and the proximal diaphyseal stress fracture. The radiographic characteristics associated with proximal diaphyseal stress fractures of the fifth metatarsal can vary by the chronicity; however, the findings typically entail a radiolucent fracture line with surrounding reactive sclerosis. In addition, a reduced medullary canal width can be appreciated. In the present retrospective analysis of patients with stress-related trauma to the fifth metatarsal base with an adducted forefoot, 2012 foot trauma cases were reviewed at 3 separate institutions. Of the 2012 cases, 22 (1.11%) met the outlined criteria of stress fractures of the fifth metatarsal base and underlying metatarsus adductus
Click to expand...

NewsBot · Feb 2, 2017

RESTRICTION IN HIP INTERNAL ROTATION AND 5TH METATARSAL STRESS FRACTURES (JONES FRACTURE) IN PROFESSIONAL FOOTBALL PLAYERS
Yoshitomo Saita et al
Br J Sports Med 2017;51:381 doi:10.1136/bjsports-2016-097372.247

Background Fifth metatarsal stress fracture (Jones fracture) is one of the issues of sports-related injuries.

Objective Exploration of unknown risk factor for developing Jones fractures.

Design Case control study.

Setting Retrospective cohort study in male Japanese professional football (soccer) players.

Patients (or Participants) Case control study conducted between with (n=20) and without (n=40) the history of Jones fractures.

Interventions (or Assessment of Risk Factors) Reviewed the medical check data regarding the joint and muscle tightness at the time they joined the team, and compared them between two groups.

Main Outcome Measurements Risk factors to develop developing Jones fracture.

Results The mean age sustaining Jones fracture was 20.5 years old (95% CI, 19.1–21.8, range 17–28). The fracture occurred in their non-dominant (standing) legs in 60% (12/20) of players. Among the physical examination data, Hip internal rotation (HIR) was significantly restricted in players with history of Jones fracture (25.9 degrees on average) compared with those without Jones fractures (40.4 degrees, p<0.0001). Logistic regression demonstrated that the wider range of HIR was associated with a statistically significantly decreased odds of Jones fracture (OR=0.83, 95% CI=0.75–0.91), while other physical examination data were not significant. A post-estimation analyses demonstrated that a 10-degree reduction in HIR of the right hip significantly increased the odds of Jones fracture in ipsilateral or contralateral foot (OR=3.11, 95% CI=1.35–7.16, and OR=2.24, 95% CI=1.22–4.12, respectively). Similarly, a reduction in HIR of the left hip significantly increased the odds of Jones fracture in ipsilateral or contralateral foot (OR=2.77, 95% CI=1.08–7.08, and OR=4.88, 95% CI=1.56–15.28, respectively).

Conclusions Restriction of HIR was significantly associated with increased risk of Jones fracture in professional football players in Japan.
Click to expand...

NewsBot · Feb 2, 2017

PROXIMAL FIFTH METATARSAL STRESS FRACTURES; SCREENING AND TREATMENT FOR INCOMPLETE FRACTURES
Hiroko Ueki et al
Br J Sports Med 2017;51:399 doi:10.1136/bjsports-2016-097372.293

Background Proximal fifth metatarsal stress fractures (so called Jones fractures) usually occur due to chronic repetitive forces. Soccer players on the status of incomplete fracture don't complain about pain while playing soccer; they can keep playing until progressing to the state of complete fractures. Jones fractures are known for prolonged healing time, high rate of non-union and re-injury. Therefore, it is critical to screen athletes with incomplete fracture.

Objective To evaluate the effectiveness of "Jones fracture screening" on its prevention for progression from incomplete to complete fracture.

Design Prospective cohort study.

Setting Collegiate and high school soccer players.

Patients Seventy-six players who agreed to participate in the primary screening test.

Interventions Educational lectures regarding Jones fracture, questionnaires as well as medical checkup including physical examination and ultrasound were conducted in players' school gymnasium as a primary screening. Hump sign, defined as cortex bulging, and increased blood flow around the fracture area in the Doppler ultrasound were defined as positive. Secondary medical examination with X-rays was then conducted for those who were positive for the primary screening. Players with Jones fractures identified by X-rays were then treated conservatively and followed up until radiographic bone union was achieved.

Main Outcome Measurements Radiographic bone union.

Results Sixteen players were screened as positive in the primary screening. All positive players received secondary examination, and three players with Jones fracture were identified. Two players had an incomplete fracture and another had an old incomplete fracture. In all players bone union was achieved after conservative treatment without quitting playing soccer.

Conclusions The use of ultrasonography would be effective to diagnose incomplete Jones fractures. Jones fracture screening can enlighten about the risk of Jones fractures and may prevent soccer players from progressing from incomplete to complete fracture without quitting playing soccer.
Click to expand...

NewsBot · Feb 2, 2017

THE RISK FACTORS OF 5TH METATARSAL STRESS FRACTURE IN FOOTBALL PLAYERS
Sho Matsuda, Norikazu Hirose, Toru Fukubayashi
Br J Sports Med 2017;51:358-359 doi:10.1136/bjsports-2016-097372.189

Background No firm consensus has been established regarding the risk factors for stress fracture of the 5th metatarsal because of a lack of large-scale prospective studies.

Objective The purpose of this study was to clarify the risk factors for a stress fracture of the 5th metatarsal.

Design Cohort study.

Setting Prospective study with well-trained varsity players.

Participants One hundred and sixty healthy collegiate male football (soccer) players.

Assessment of Risk Factors The medial lateral arch ratio of the foot, leg-heel alignment with weight-bearing (WLHA), LHA without weight-bearing (NLHA), relative angle of the forefoot to the hindfoot (FA-H), and plantar pressure during the heel raise position were measured. Rearfoot and forefoot alignment were evaluated from images using Image J. The plantar pressure distribution was measured using a plate-type lower limb GP-6000 weighted meter and pressure distribution-measuring MD-1000 device from Anima Co., Ltd.

Main Outcome Measurements The measurements from players who were diagnosed with a stress fracture of the 5th metatarsal were compared with the measurements from non-injured players.

Results Four players were diagnosed with a stress fracture of the 5th metatarsal. The arch ratio, WLHA, and FA-R of the injured players were higher than those of the non-injured players (17.8±0.21 vs. 1.68±0.26, −3.79±2.5° vs. −4.24±2.93°, 4.34±3.62° vs. 3.19±5.18°). The NLHA of the injured players was lower than that of the non-injured players (3.08±2.29° vs. 6.03±4.51°). The plantar pressure of the injured players tended to be located in a more lateral position compared with the non-injured players during heel raise (55.41±1.59% vs. 47.93±4.59%).

Conclusions Stress on the lateral side of the foot during heel raise may cause stress fractures of the 5th metatarsal.
Click to expand...

Admin2 · Apr 29, 2017

Range limitation in hip internal rotation and fifth metatarsal stress fractures (Jones fracture) in professional football players
Saita, Y., Nagao, M., Kawasaki, T. et al.
Knee Surg Sports Traumatol Arthrosc (2017). doi:10.1007/s00167-017-4552-4

Purpose
To identify unknown risk factors associated with fifth metatarsal stress fracture (Jones fracture).

Methods
A case–controlled study was conducted among male Japanese professional football (soccer) players with (N = 20) and without (N = 40) a history of Jones fracture. Injury history and physical examination data were reviewed, and the two groups were compared. Univariate and multivariate logistic regression controlling for age, leg dominance and body mass index were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to describe the association between physical examination data and the presence or absence of Jones fractures.

Results
From 2000 to 2014, among 162 professional football club players, 22 (13.6%; 21 Asians and one Caucasian) had a history of Jones fracture. Thirteen out of 22 (60%) had a Jones fracture in their non-dominant leg. The mean range of hip internal rotation (HIR) was restricted in players with a history of Jones fracture [25.9° ± 7.5°, mean ± standard deviation (SD)] compared to those without (40.4° ± 11.1°, P < 0.0001). Logistic regression analyses demonstrated that HIR limitation increased the risk of a Jones fracture (OR = 3.03, 95% CI 1.45–6.33, P = 0.003). Subgroup analysis using data prior to Jones fracture revealed a causal relationship, such that players with a restriction of HIR were at high risk of developing a Jones fracture [Crude OR (95% CI) = 6.66 (1.90–23.29), P = 0.003, Adjusted OR = 9.91 (2.28–43.10), P = 0.002]. In addition, right HIR range limitation increased the risks of developing a Jones fracture in the ipsilateral and the contralateral feet [OR = 3.11 (1.35–7.16) and 2.24 (1.22–4.12), respectively]. Similarly, left HIR range limitation increased the risks in the ipsilateral or the contralateral feet [OR (95% CI) = 4.88 (1.56–15.28) and 2.77 (1.08–7.08), respectively].

Conclusion
The restriction of HIR was associated with an increased risk of developing a Jones fracture. Since the HIR range is a modifiable factor, monitoring and improving the HIR range can lead to prevent reducing the occurrence of this fracture.
Click to expand...

NewsBot · Aug 9, 2017

Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study.
Matsuda S et al
Sports Med Open. 2017 Dec;3(1):27. doi: 10.1186/s40798-017-0095-y

BACKGROUND:
There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures.
METHODS:
The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg-heel alignment, non-weight-bearing leg-heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure.
RESULTS:
The non-weight-bearing leg-heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P = 0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P < 0.05). There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain.
CONCLUSIONS:
Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future.
Click to expand...

NewsBot · Nov 27, 2017

Stress Fracture of the Fifth Metatarsal in Foot Deformity Secondary to Neuromuscular Disease: Experiences of Deformity Correction Treatment—A Report of 3 Cases and Review of the Literature
Jesús Payo-Ollero, MD, Fernando Álvarez Goenaga, MD, Gotzon Elorriaga Sagarduy, MD, ...
Foot & Ankle Specialist November 25, 2017

Fractures at the proximal metaphyso-diaphyseal junction of the fifth metatarsal are associated with high rates of delayed union. When these fractures are the result of repeated stress in patients with equinovarus hindfoot, which in turn is caused by neurological disorders, delayed union is the rule. Therefore, in neurological patients with stress fractures, optimal treatment would be to achieve a plantigrade foot enabling them to relieve the fifth metatarsal overload, which prevents the consolidation. We report 3 cases of fifth metatarsal stress fracture resulting from an equinovarus hindfoot deformity caused by a neuromuscular disease. Our surgical indication was to correct the foot deformity with no direct action on the fracture. Once a good alignment (plantigrade foot) was obtained, stress causing the fracture disappeared, and union was achieved with optimal biomechanical function in all 3 fractures. When stress fracture of the fifth metatarsal is caused by a secondary foot deformity, treating the deformity can lead to healing the fracture efficiently and should be considered prior to indicating surgical stabilization of the fracture itself. Primary treatment of the fracture with no correction of the deformity leads to therapeutic failure.
Click to expand...

NewsBot · Sep 2, 2018

Early return to playing professional football following fixation of 5th metatarsal stress fractures may lead to delayed union but does not increase the risk of long-term non-union.
Miller D et al
Knee Surg Sports Traumatol Arthrosc. 2018 Aug 28.

PURPOSE:
5th metatarsal stress fractures are frequently encountered in professional football. There is concern that early return to play following intra-medullary screw fixation may lead to an increased risk of delayed union. The purpose of the study was to assess whether an early return to play after surgical fixation of 5th metatarsal fractures in professional football players is a risk factor for delayed union and the effect of this on the ultimate clinical outcome.

METHODS:
Retrospective review of prospectively collected data of a series of 37 professional football players following intramedullary screw fixation of 5th metatarsal stress fractures. End points included time of return to play and to radiological union of the fracture.

RESULTS:
At a minimum follow-up of 24 months the mean return to play was 10.5 weeks and mean time to complete radiological union was 12.7 weeks. Return to play at 8 weeks or less resulted in a higher risk of delayed radiological union (24% at 3 months), but this neither prevented the athlete from continuing to play football nor did it affect the ultimate risk of non-union (3% overall). A re-fracture occurred in 1 patient (3%) at 10 months who previously had complete radiographic union at 9 weeks.

CONCLUSION:
Intramedullary screw fixation of 5th metatarsal stress fractures leads to a predictable time of return to play and a low rate of non-union. If players return to play at 8 weeks or less a persistent line may be expected in up to a quarter of patients. However, if asymptomatic this radiological finding does not mean that athletes must avoid playing football as ultimately a good outcome is expected with low rates of non-union and refracture.
Click to expand...

NewsBot · Feb 17, 2019

Ankle Structures of Professional Soccer (Football) Players With Proximal Diaphyseal Stress Fractures of the Fifth Metatarsal
KazuhaKizakiMDFumiharuYamashitaMD, PhDDaisukeMoriMDNoboruFunakoshiMD
The Journal of Foot and Ankle Surgery; 11 February 2019

Despite a high incidence of proximal diaphyseal stress fractures of the fifth metatarsal (zone 3) in soccer (football) players, studies that examine risk factors of the fractures in professional soccer players are scarce; in particular, ankle structures have not yet been investigated. This study was designed to investigate ankle structures of professional soccer players with proximal diaphyseal stress fractures of the fifth metatarsal. We reviewed the ankle radiographs of 100 professional soccer players (stress fractures n = 15; controls n = 85) and measured the medial malleolar slip angle (MMSA), the ratio of the medial malleolar length to the width of the talar dome (MML:TD ratio), the ratio of the lateral malleolar length to the width of the TD (LML:TD ratio), and the ratio of the MML to the LML (MML:LML ratio). The MMSA (p < .01: 28.7° ± 5.8° versus 23.0° ± 4.9°) in the stress fractures was significantly wider and the MML:TD ratio (p = .08: 0.49 ± 0.08 versus 0.52 ± 0.07) had a trend to be smaller compared with the values of the controls. Logistic regression analysis revealed that a wider malleolar slip angle became a factor associated with stress fractures in professional soccer players (p < .01: odds ratio 1.27, 95% confidence interval 1.110 to 1.463). Receiver operating characteristic curve with MMSA for the stress fractures was depicted with an area under the curve of 0.778, and the suitable cut-off point was set at MMSA >27° with a positive likelihood ratio of 3.67 (95% confidence interval 2.173 to 6.188). Our study results show that a wide MMSA was associated with proximal diaphyseal stress fractures of the fifth metatarsal in professional soccer players.
Click to expand...

Admin2 · Feb 27, 2019

Playing football on artificial turf as a risk factor for fifth metatarsal stress fracture: a retrospective cohort study
Takayuki Miyamori et al
BMJ Open 2019;9:e022864

Objective The fifth metatarsal stress fracture is a common injury among football players. Although several risk factors have been proposed, the association between the playing surface and development of fifth metatarsal stress fractures (MT-5) has not been evaluated. We conducted an epidemiological study using a computer-based survey to investigate the association between the playing surface and development of MT-5.

Methods This study included 1854 football players, of which 41 experienced MT-5 within the past 24 months. Baseline demographic data and the percentage of time spent playing on artificial turf and clay fields were compared between the non-MT-5 and MT-5 player groups, and the risks for development of MT-5 associated with the playing surfaces were estimated by univariate and multivariate analyses.

Results There were significant differences in body mass index, years of play, playing categories and playing time on artificial turf between non-MT-5 and MT-5 groups (p<0.05). Generalised estimating equations analyses adjusted for multiple confounders demonstrated that relative to the risk of playing <20% of the time on each surface, the OR (OR: 95% CI) for MT-5 for playing on artificial turf >80% of the time increased (3.44: 1.65 to 7.18), and for playing on a clay field 61%–80% of the time, the OR decreased (0.25: 0.11 to 0.59).

Conclusions A higher percentage of playing time on an artificial turf was a risk factor for developing MT-5 in football players. This finding could be beneficial for creating strategies to prevent MT-5.
Click to expand...

NewsBot · Oct 10, 2019

This clinical trial was just registered:\Effectiveness of Shockwave Treatment for Proximal Fifth Metatarsal Stress Fracture in Soccer Players

Fifth metatarsal stress fracture is a failure of a healthy metatarsal bone subject to repetitive microdamages. It has a high prevalence in soccer players and is classified as a high-risk stress fracture. Based on Torg classification, the treatment options may be conservative or surgical. The recent increase of evidences about Shock Wave Treatment in different bone pathologies, including stress fractures, suggests the possibility to use this conservative intervention option also in patients candidate for surgery. This randomized clinical trial included 18 soccer players diagnosed of proximal fifth metatarsal stress fracture, randomly matched in Surgery group and Shock Wave group. Patients of Surgery group were treated with intramedullary screw fixation; patients of Shock Wave group received 3 weekly sessions of Focused Shock Wave Treatment (F-ESWT), using an electrohydraulic device set to an energy flux density (EFD) of 0.21 mJ/mm2 and 2000 impulses. Patients of both groups were followed monthly until their return to play (RTP) using radiography, Visual Analogue Scale (VAS), Tegner Activity Level Scale and AOFAS score.
Click to expand...

NewsBot · Jan 11, 2020

Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture.
Young KW et al
Foot Ankle Int. 2020 Jan 6

BACKGROUND:
The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating.

METHODS:
Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months.

RESULTS:
The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks.

CONCLUSION:
With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems.
Click to expand...

NewsBot · Mar 7, 2020

Prevention of fifth metatarsal bone stress fracture in youth japanese soccer players
Yoshitomo Saita et al
British Journal of Sports Medicine 2020;54:A86.

Background The stress fracture of the fifth metatarsal bone (5MT) frequently occurs in youth soccer players in Japan, and it is very important issue to prevent this fracture.

Objective To confirm whether preventive intervention successfully reduced the incidence of 5MT.

Design Observational cohort study to compare the occurrence of 5MT before (2003–2009) and after (2010–2016) intervention.

Setting One football (soccer) club in Japan.

Patients (or Participants) One hundred and fifty-nine elite Japanese youth (under 18) football (soccer) players belonged to one football club from 2003 to 2016. The incidence of 5MT were compared before intervention (7 years) and after intervention (7 years).

Interventions (or assessment of risk factors) We proposed the prevention strategy on 2010 based on our clinical experiences and past publications regarding with 5MT (https://saita0617.wixsite.com/jones/english-ver ).

Main outcome measurements Incidence of 5MT.

Results The incidence of 5MT before intervention was 11 cases, while it was decreased to 2 cases after intervention. The hazard ratio for the incidence of 5MT was 3.99 (95%CI: 1.06 to 15.05, p=0.04) in the 88 soccer players prior to prevention compared with 71 players post prevention.

Conclusions The prevention intervention was effective to reduce the incidence of 5MT in youth Japanese football players.
Click to expand...

NewsBot · Jun 4, 2020

Recurrent fifth metatarsal stress fractures in a professional soccer player with hypoparathyroidism: a case report
Itaru Kawashima, Atsushi Yamaga, Ryosuke Kawai, Yushi Hoshino & Shinya Ishizuka
BMC Musculoskeletal Disorders volume 21, Article number: 347 (2020)

Background
Hypoparathyroidism is characterized by low or inappropriately normal levels of parathyroid hormone leading to hypocalcemia. In this report, a case of recurrent fifth metatarsal stress fractures in a professional soccer player with hypoparathyroidism is presented.

Case presentation
A 23-year-old male professional soccer player developed left foot pain. He had no specific medical or family history. He was diagnosed with a fifth metatarsal stress fracture and underwent osteosynthesis with a cannulated cancellous screw 3 days after the injury. After three and a half months, the X-ray showed bone union, and he returned to full sports activity. However, he felt pain in his left foot again, and a re-fracture was found on X-ray a week later. Osteosynthesis was performed again. Two months after re-operation, the cause of re-fracture was investigated. Laboratory results showed abnormally low levels of serum calcium (8.4 mg/dL) and intact parathyroid hormone (i-PTH: 19.0 pg/mL). However, other laboratory examinations were normal. Therefore, he was diagnosed with primary hypoparathyroidism according to the diagnostic criteria. Medical treatment was started with alfacalcidol 1.0 μg/day. One month after starting medication, the serum calcium improved to 9.4 mg/dL. Four months after the re-operation, the X-ray showed bone union, and he was therefore allowed to play soccer. While he played professional soccer, there were no new subjective complaints.

Conclusions
Hypoparathyroidism may be one of the risk factors for stress fractures. We believe that serum calcium levels should be checked in patients with stress fractures, and if the serum calcium is low, hypoparathyroidism should be considered.
Click to expand...

NewsBot · Jun 17, 2020

Conservative Treatment of Refractures After Modified Tension Band Wiring of Fifth Metatarsal Base Stress Fractures in Athletes
Kyung Tai Lee et al
J Orthop Surg (Hong Kong). Jan-Apr 2020;28(2)

Objective: Recurrent fifth metatarsal base stress fractures (MT5-BSF) in athletes present a challenging problem. The aim of this study was to evaluate the result of conservative treatment for the refracture of MT5-BSF after modified tension band wiring (MTBW).

Materials and methods: The outcomes of 15 elite athletes undergoing conservative treatment for refracture of MT5-BSF after MTBW were retrospectively reviewed. They were instructed to avoid weight-bearing with short leg cast for 6 weeks. After that, they started partial weight with a postop shoe. Stepwise exercise followed bone union by radiographs.

Results: Thirteen cases (86.6%) had a complete bone union after a mean of 18.9 ± 8.6 weeks. Twelve cases (80%) returned to their previous activity level and maintained for at least two consecutive seasons.

Conclusion: Eighty percent of all athletic patients with the conservative treatment for refractures with healed MT5-BSF after MTBW on the plantar-lateral side could maintain and return to their previous sports activity for at least 2 years.
Click to expand...

NewsBot · Feb 25, 2021

High union rates following surgical treatment of proximal fifth metatarsal stress fractures
Julian J. Hollander, Quinten G. H. Rikken, Jari Dahmen, Sjoerd A. S. Stufkens & Gino M. M. J. Kerkhoffs
Knee Surgery, Sports Traumatology, Arthroscopy (2021)

Purpose
The primary purpose of this study was to determine the union rate and time for surgical- and non-surgical treatment of stress fractures of the proximal fifth metatarsal (MT5). The secondary purpose was to assess the rate of adverse bone healing events (delayed union, non-union, and refractures) as well as the return to sports time and rate.

Methods
A literature search of the EMBASE (Ovid), MEDLINE (PubMed), CINAHL, Web of Science and Google Scholar databases until March 2020 was conducted. Methodological quality was assessed by two independent reviewers using the methodological index for non-randomized studies (MINORS) criteria. The primary outcomes were the union time and rate. Secondary outcomes included the delayed union rate, non-union rate, refracture rate, and return to sport time and rate. A simplified pooling technique was used to analyse the different outcomes (i.e. union rate, time to union, adverse bone healing rates, return to sport rate, and return to sport time) per treatment modality. Additionally, 95% confidence intervals were calculated for the union rate, adverse bone healing rates, and the return to sport rate.

Results
The literature search resulted in 2753 articles, of which thirteen studies were included. A total of 393 fractures, with a pooled mean follow-up of 52.5 months, were assessed. Overall, the methodological quality of the included articles was low. The pooled bone union rate was 87% (95% CI 83–90%) and 56% (95% CI 41–70%) for surgically and non-surgically treated fractures, respectively. The pooled radiological union time was 13.1 weeks for surgical treatment and 20.9 weeks for non-surgical treatment. Surgical treatment resulted in a delayed union rate of 3% (95% CI 1–5%), non-union rate of 4% (95% CI 2–6%) and refracture rate of 7% (95% CI 4–10%). Non-surgical treatment resulted in a delayed union rate of 0% (95% CI 0–8%), a non-union rate of 33% (95% CI 20–47%) and a refracture rate of 12% (95% CI 5–24%), respectively. The return to sport rate (at any level) was 100% for both treatment modalities. Return to pre-injury level of sport time was 14.5 weeks (117 fractures) for surgical treatment and 9.9 weeks (6 fractures) for non-surgical treatment.

Conclusion
Surgical treatment of stress fractures of the proximal fifth metatarsal results in a higher bone union rate and a shorter union time than non-surgical treatment. Additionally, surgical and non-surgical treatment both showed a high return to sport rate (at any level), albeit with limited clinical evidence for non-surgical treatment due to the underreporting of data.
Click to expand...

NewsBot · Apr 16, 2021

Stress Fractures of the Fifth Metatarsal in Athletes
Patel, Karan A. MD; Christopher, Zachary K. MD; Hubbard, Christopher E. MD; O'Malley, Martin J. MD
Journal of the American Academy of Orthopaedic Surgeons: April 7, 2021

Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably high nonunion and refracture rates. Surgical fixation remains the treatment of choice in the athletic cohort, and intramedullary screw fixation with a solid screw has been established as the most predictable means of achieving a successful outcome. Recently, the use of a plantar plate has also been advocated as has been shown in some studies to be more biomechanically advantageous. The use of bone grafting at the primary surgery and morphology and screw type are also important decisions to be made when treating these patients. This review will discuss our management of both primary fractures and refractures of the fifth metatarsal in athletes
Click to expand...

NewsBot · Oct 17, 2021

The Effectiveness of Intramedullary Screw Fixation Using the Herbert Screw for Fifth Metatarsal Stress Fractures in High-Level Athletes
Shota Morimoto, MD, Tomoya Iseki, MD, PhD, Takatoshi Morooka, MD, PhD, ...
The American Journal of Sports Medicine October 15, 2021

Intramedullary screw fixation is the most common operative procedure used for treatment of fifth metatarsal stress fractures in athletes. However, the optimal implant in intramedullary screw fixation is still being investigated.

Purpose:
To review experiences with intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures in high-level athletes.

Study Design:
Case series; Level of evidence, 4.

Methods:
The authors retrospectively analyzed 37 high-level athletes (Tegner activity score ≥7) who underwent intramedullary screw fixation using the Herbert screw for fifth metatarsal stress fractures between August 2005 and August 2017. The minimum follow-up period of the patients was 2 years. In assessing the surgical results, time to obtain bone union, time to return to original level of sport participation, and treatment failures/complications were reviewed. Additionally, the effect of intraoperative plantar gap widening caused by the screw insertion was analyzed. The surgical results of the 2 groups, the no-gap group (intraoperative plantar gap widening, <1 mm) and the gap group (intraoperative plantar gap widening, ≥1 mm), were compared, while correlations between intraoperative plantar gap widening and the surgical results were statistically analyzed.

Results:
Bone union and return to the original sport were attained in all patients without treatment failures/complications such as delayed union, nonunion, or refracture. The mean time to obtain bone union was 10.1 weeks, and the mean time to return to sport was 10.9 weeks. In comparing the no-gap group (n = 16) and the gap group (n = 21), no significant differences in the time to obtain bone union (P = .392) or to return to sport (P = .399) were noted. Additionally, there was no correlation between intraoperative plantar gap widening and the time to obtain bone union (r = 0.131; P = .428) or to return to sport (r = 0.160; P = .331).

Conclusion:
The use of the Herbert screw for intramedullary screw fixation to treat fifth metatarsal stress fractures in high-level athletes provided satisfactory results enabling all the athletes to return to the original sport without treatment failures/complications. Additionally, intraoperative plantar gap widening does not affect the surgical results using this technique
Click to expand...

NewsBot · Nov 4, 2023

Shockwave Treatment vs Surgery for Proximal Fifth Metatarsal Stress Fractures in Soccer Players: A Pilot Study
Silvia Ramon et al
Foot Ankle Int. 2023 Oct 31

Background: To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study.

Methods: Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles-Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm2 and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups.

Results: No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups.

Conclusion: In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

The Plantar Gap: Another Prognostic Factor for Fifth Metatarsal Stress Fracture

Fifth metatarsal stress fracture..

Stress Fracture of the Fifth Metatarsal Bone as a Late Complication of Total Knee Arthroplasty

Fifth Metatarsal Fracture 23 wks later

Fifth metatarsal head inflammation and pain

Fifth Metatarsal Intramedullary Screw Head Cuboid Impingement

Refractory Symptomatic Fourth and Fifth Tarsometatarsal Joints

Share This Page