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Metatarsal Stress Frx

- See: Forefoot and Midfoot Stress Frx

- Discussion:
    - march frx usually occurs in shaft of second or less often in the third metatarsal;
           - stress frx of 5th metatarsal represents a distinct fracture;
    - in runners stress frxs occur most often in metatarsal neck, while in dancers, stress frxs usually occur in proximal shaft;
    - in ballet dancers, frx occur at base of second metatarsal & Lisfranc's;
    - frx  results from stress of wt bearing after prolonged walking;
    - only rarely is there a history of direct trauma to the foot;
    - always consider whether osteoporosis or osteomalacia is present;

- Exam:
    - look for point tenderness over an area of induration or palpable mass;
    - note that cavus feet are a risk factor for stress frx;

- Radiographs:
    - frx callus is not seen until 3 weeks after the initial insult;
    - a hot lamp is useful to see the callus;
    - bone scans: are positive early;


- Treatment:
    - reduction of activity for 6 to 12 weeks, wooden soled shoe, or cast;
    - in rare cases in which stress frx occur with a cavus foot, plantar fascia release may be appropriate

Effect of varying arch height with and without the plantar fascia on the mechanical properties of the foot

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