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Fracture, Stress: Metatarsal, Navicular, Sports Medicine

Stephen M. Simons, MD, FACSM and Christopher Jordan, MD, ATC, CAQSM Reviewed 04/2019
 


BASICS

DESCRIPTION

  • Overload, repetitive stress injury to bone

  • Manifest as fatigue fractures to otherwise normal bone

EPIDEMIOLOGY

  • Stress fractures account for 10% of overuse injuries in sports 1. Stress f...

DIAGNOSIS

HISTORY

  • Pain onset acute or insidious? Usually insidious

  • Pain location? Site of fracture; forefoot for metatarsal stress fractures and dorsomedial midfoot for tarsal navicular stress fractures...

TREATMENT

GENERAL MEASURES

  • Metatarsals:

    • Cease sporting activities.

    • Non–weight-bearing only needed for pain control

    • Rest period, average 6 wk

  • Navicular:

    • Non–weight-bearing on crutches with below-the-knee cas...

ONGOING CARE

  • Metatarsals 6[C]:

    • Modify activity level and training activities to provide relative rest.

    • Address abnormal biomechanics.

    • Consider calcium and vitamin D supplementation.

    • Return to progressive ...

REFERENCES

1
McInnis KC, Ramey LN. High-risk stress fractures: diagnosis and management. PM R.  2016;8(Suppl 3):S113–S124.
2
Welck MJ, Hayes T, Pastides P, et al. Stress fractures of the foot and an...

ADDITIONAL READING

  • Cheung CN, Lui TH. Proximal fifth metatarsal fractures: anatomy, classification, treatment and complications. Arch Trauma Res.  2016;5(4):e33298.

  • Thompson P, Patel V, Fallat LM,...

CLINICAL PEARLS

  • Risk factors for stress fractures include overuse or training errors, biomechanical factors, choice and/or age of shoe, nutrition, and menstrual issues for women.

  • Careful attention to t...

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