Second metatarsal stress fractures

NewsBot · Sep 11, 2007

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Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations.
Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA.
Br J Sports Med. 2007 Aug;41(8):510-4.

BACKGROUND: Stress fractures of the second metatarsal are common injuries in athletes and military recruits. There are two distinct areas in the second metatarsal where stress fractures develop: one proximal (at the base) and the other non-proximal (distal). Diagnosis can be difficult, and there is a difference in prognosis and treatment of the two types of stress fracture. Therefore differentiation of fracture location is warranted. Differences in risk factors and clinical outcomes between proximal and non-proximal stress fractures have not been studied.

OBJECTIVE: To determine whether different risk factors and/or clinical outcomes associated with proximal and non-proximal stress fractures of the second metatarsal exist.

METHODS: Patients diagnosed with proximal stress fractures of the second metatarsal were included in the study. Retrospectively, an age-matched control group with a non-proximal stress fracture was selected for comparison. Statistical analysis involved bivariate comparisons of demographic variables and clinical measurement between the two groups.

RESULTS: Patients with proximal stress fractures were more likely to be chronically affected, usually exhibited an Achilles contracture, showed differences in length of first compared with second metatarsal, were more likely to experience multiple stress fractures, and exhibited low bone mass. In addition, a high degree of training slightly increased the risk of a non-proximal fracture, whereas low training volume was associated with a proximal stress fracture.

CONCLUSION: The signs, symptoms and clinical findings associated with proximal metatarsal stress fractures are different from those of non-proximal stress fractures.
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Admin2 · Sep 11, 2007

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NewsBot · Oct 10, 2007

The influence of second toe and metatarsal length on stress fractures at the base of the second metatarsal in classical dancers.
Davidson G, Pizzari T, Mayes S.
Foot Ankle Int. 2007 Oct;28(10):1082-6.

BACKGROUND: Stress fractures at the base of the second metatarsal frequently occur in female classical dancers. There is a strong belief that a foot shape in which the first metatarsal or toe is shorter than the second metatarsal or toe increases the risk of this injury in dancers. However, there is a lack of empirical evidence to support this theory. The objective of this study was to examine the influence of the relative length difference between the first and second metatarsals and first and second toes on the frequency of stress fractures at the base of the second metatarsal in elite, female classical dancers.

METHODS: Both feet of 50 elite female classical dancers were measured for length differences between the first and second toes and first and second metatarsals. Retrospective analysis of dancers' medical histories revealed 17 feet with stress injury and 83 without. The mean of the difference between the metatarsal and toe length for the stress-injury group was compared to that of the control group.

RESULTS: No difference between the groups was identified for first and second toe length difference (p = 0.865) and the relative difference between the ends of the first two metatarsals (p = 0.815).

CONCLUSIONS: Dancers who had a stress injury at the base of the second metatarsal displayed similar variances in the two independent variables as dancers who had not had such an injury.
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NewsBot · Oct 16, 2010

Metatarsal Length does not Correlate with Maximal Peak Pressure and Maximal Force.
Kaipel M, Krapf D, Wyss C.
Clin Orthop Relat Res. 2010 Oct 13. [Epub ahead of print]

BACKGROUND: Primary metatarsalgia of the lesser metatarsals is common and caused by mechanical overload of the affected metatarsal heads. Increased metatarsal length generally is believed to be a factor in the development of primary metatarsalgia. However, there is no clear biomechanical evidence supporting this theory.

QUESTIONS/PURPOSES: We asked whether metatarsal length correlated with plantar-loading parameters under the corresponding metatarsal heads.

PATIENTS AND METHODS: We prospectively followed two groups of patients 46 (51 feet) with and 45 (51 feet) without metatarsalgia. Each foot was physically examined and underwent standardized full-weightbearing radiography and dynamic pedobarography to assess maximal peak pressure and maximal force under the first, second, and third metatarsal heads. We correlated the relative length of the first and third metatarsals with the corresponding two plantar-loading parameters. We compared maximal peak pressure and maximal force in patients with metatarsalgia with those of symptom-free patients.

RESULTS: The relative length of the first and third metatarsals did not correlate (r < 0.13) with the maximal peak pressure or maximal force under the corresponding metatarsal heads. Maximal force under the first metatarsal head was decreased in the metatarsalgia group. There was no difference in maximal peak pressure between the metatarsalgia and nonmetatarsalgia groups.

CONCLUSIONS: Relative metatarsal length had no influence on plantar-loading parameters. Shortening of a symptomatic ray to decrease plantar-loading parameters cannot be supported from a biomechanical rationale.
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Kevin Kirby · Oct 16, 2010

Shortening of a symptomatic ray to decrease plantar-loading parameters cannot be supported from a biomechanical rationale.
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Why do researchers take such leaps from their research data when their study did not measure "shortening of a symptomatic ray" (which I assume to mean surgical shortening)? Their data measured length versus pressure of the ray, not changes in pressure with surgical shortening of the metatarsal ray.

Craig Payne · Oct 16, 2010

Kevin Kirby said: ↑

Why do researchers take such leaps from their research data when their study did not measure "shortening of a symptomatic ray" (which I assume to mean surgical shortening)? .
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My lecture topic for a recent conference was supposed to be something like "the clinical implications of recent biomechanical research" ... to my embarrasment I could find nothing in the last few yrs that was worthy of talking about. Like the above, I found plenty of good research where researchers stretched what clinical implications they think their research has .... the problem is that no clinician would agree with them.

efuller · Oct 18, 2010

If I recall correctly one of these two papers did show a correlation between metatarsal length and plantar pressure.

Structural and functional predictors of regional peak pressures under the foot during walking.
Morag E, Cavanagh PR.
J Biomech. 1999 Apr;32(4):359-70.PMID: 10213026

The relationship of static foot structure to dynamic foot function.
Cavanagh PR, Morag E, Boulton AJ, Young MJ, Deffner KT, Pammer SE.
J Biomech. 1997 Mar;30(3):243-50.

Eric

NewsBot · Jul 6, 2021

Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning
Journal of Orthopaedic & Sports Physical Therapy June 30, 2021

Background
Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running.

Clinical Question
What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running?

Key Results
Optimal load can be guided by knowledge of the BSI healing process and is symptom driven. At all stages, the optimal load does not produce symptoms during, after, or the day following loading.

Clinical Application
A period of initial load reduction, via partial or non–weight bearing, is typically needed to alleviate presenting symptoms. Analgesics or nonsteroidal anti-inflammatory drugs may be used in the short term (sooner than 7 days), but only for resting pain and night pain. Healing supplements (eg, low-intensity pulsed ultrasound and/or recombinant parathyroid hormone therapy) may be attempted to influence tissue healing. Athletes can maintain cardiopulmonary fitness via cross-training, while simultaneously addressing musculoskeletal fitness. A return-to-run program can be initiated once an athlete is pain free during daily activities for 5 consecutive days. Progress is directed by symptom provocation and initially focuses on increasing running volume before speed. Optimal loading should be continued following return to running and may include jump training and/or gait retraining to reduce subsequent BSI risk. The optimal loading approach to managing low-risk tibial and metatarsal BSIs is clinically successful, but requires further scientific validation.
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