![]() ![]() ![]() Patient history was collected including specific topics such as the duration of symptoms and history of other stress fractures. General demographic data (including age, sex, marital status, weight, height, body mass index, race, work and recreational activities) were recorded as well as specific sport participation and level of sport participation (operationally defined as 15 h a week). Like the group with proximal stress fractures, all subjects underwent a complete radiographic examination, including foot plain AP, oblique and lateral radiography for initial diagnosis followed by a method of confirmatory diagnosis. The control group was age matched (based on 5 years difference). Retrospectively, a comparison control group was enrolled if they exhibited a stress fracture of the second metatarsal in any region other than the proximal base of the bone. All were patients at Duke University Medical during the period 1996–2005. Those with measurable low bone mass were treated appropriately with osteoporosis medication if not contraindicated. All patients received bone densitometry after the diagnosis had been made to determine the contribution of bone mass to the stress fracture. Because of the difficulty in diagnosing a metatarsal stress fracture, a confirmatory diagnosis was sometimes made using MRI or bone scan. They underwent a complete radiographic examination, including foot plain anterior to posterior (AP), oblique and lateral radiography for initial diagnosis. Patients retrospectively diagnosed with a proximal stress fracture of the second metatarsal were included in this study. We hypothesise that the identifying factors associated with each fracture are indeed different and lead to mechanical explanations for each encountered stress fracture. The findings may help to identify risk factors associated with the potential for such fractures. ![]() The purpose of this study was to outline the clinical signs, symptoms and physical factors associated with proximal and non‐proximal stress fractures of the second metatarsal in a retrospective sample. 22, 23, 24 However, to date the exact risk factors and causes predicting a proximal stress fracture of the second metatarsal are still unclear. 19 Increasing load and rate to the second metatarsal is believed to be a cause of stress injury for both locations, 15, 21 as this descriptive mechanism and the clinical findings of a proximal fracture have been reported in several studies. Non‐proximal fractures usually heal well with symptomatic treatment within 6–8 weeks, whereas proximal fractures develop delayed or non‐union, which may require surgical intervention. 18, 19 Boden et al 18, 20 considered proximal fractures to be high‐risk fractures compared with non‐proximal fractures specifically in association with recuperation period, treatment needed, and the potential for complications. In addition, the recovery time of a proximal fracture is usually prolonged, and delayed and non‐union is often seen. Proximal stress fractures of the second metatarsal are much less common than non‐proximal second metatarsal stress fractures. The exact reason why non‐proximal fractures are more prevalent than proximal fractures is unclear, despite comprehensive biomechanical analysis. However, none of these factors explains why more than 95% of stress fractures of the second metatarsal occur at the non‐proximal aspect of the metatarsal bone. The association of valgus deformity of the hind foot 11, 12 with second metatarsal fractures and the presence of osteoporosis 13, 14 have also been reported. 8 Kinematic contributors to stress such as muscle fatigue 9 and the normally higher bending strains at the second digit during running 10 further increase the forces placed on the second metatarsal. 7 The second to fourth metatarsals are the weakest cross‐sectionally, despite the fact that the second and third metatarsals encounter high peak pressures during weight‐bearing activities. Anatomically, the second to fourth metatarsals have ligamentous anchoring between the heads of the metatarsal, which protect against fracture displacement, but which can increase plantar‐oriented forces during weight bearing. It has been reported that 10% 4 to 20% 5 of stress fractures in athletes and 23% 6 of stress fractures in military recruits are located in the metatarsals. 1, 2, 3 Stress fractures of the metatarsals are also common in military recruits and in long‐distance runners. 1 Stress fractures of the metatarsal bones comprise 3.7% of all sport‐related injuries, with the second and third metatarsal accounting for 80–90% of the fractures. A stress fracture of the metatarsal bones is one of the most common overuse injuries in athletes, second only to a tibial stress fracture in incidence. ![]()
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