In our clinic you can get an accurate diagnosis and effective treatment for a march fracture.
For more detailed information and to schedule a consultation, call us by phone.
Features and diagnosis of a fracture.
There are two types of such injuries - the “Deuchlander” and “Jones” marching fractures (the latter is localized over a wide area of the base of the fifth metatarsal bone). First of all, radiography is used as a diagnostic method, which makes it possible to establish the clinical picture characteristic of a given pathology.
The main symptoms of the disease are:
- Pain of varying strength in the front side of the foot (especially when walking while rolling);
- Painful lesions on the back of the upper foot (may be accompanied by small tumors about two centimeters in diameter);
- The edematous area resembles bone upon palpation in density;
- In some cases, the swelling is larger and may spread to the entire back of the ankle;
- Sharp pain in the metatarsal bone, arising due to its restructuring and changes in load;
- Painful syndrome when standing on half toes (in the final stages – inability to stand on them).
Diagnosis can be difficult because the problem is not easily identified on an x-ray. Often patients are treated for other diseases - tendonitis, bruises, and so on. In repeated photographs, the march fracture is easier to see - over time, the bone becomes deformed, and the fracture lines become more obvious. In general, the ability to recognize such fractures depends on how long ago the pathology began.
If the diagnostic situation is difficult, the doctor will:
- X-ray ¾ projection;
- Tomography.
At-risk groups.
The following are susceptible to the disease:
- Gymnasts;
- Ballerinas;
- Active tourists and travelers;
- Women who wear high heels;
- Athletes performing exercises after a long break;
- Sellers, waiters, nurses, hairdressers and representatives of other “standing” professions.
The procedure for reconstruction of the second metatarsal bone often has relapses, as well as complications in the form of a fracture with the presence of displacement of detached pieces, a slight dislocation of the proximal Lisfranc articular part.
Causes of frequent fractures in the “60+” category
As we age, metabolic processes slow down, the body loses its ability to regenerate, and osteoporosis progresses. In older people, bone density often decreases - height decreases, stooping and pathological curvature of the spine appear under its own weight. These processes are accompanied by invisible microtraumas that occur during any sudden movements.
With arthrosis, cartilage tissue wears out - individual areas of the bones rub, causing pain. It is not surprising that they gradually deform, lose strength, and microtraumas and cracks appear on them.
In addition, in old age, due to problems with the cardiovascular system, many people complain of weakness and dizziness. This increases the risk of slipping and falling - both on a slippery road and in everyday life, when performing usual actions.
According to statistics, about 10% of Russian residents suffer from osteoporosis - brittle bones
Treatment.
As a rule, they resort to a conservative method of treatment, which involves avoiding physical activity, as well as keeping the foot at rest. In addition, they use:
- Kinesio taping;
- Wearing plaster overlays;
- exercise therapy;
- Myostimulation;
- Other physiotherapeutic procedures.
Recovery takes up to six months. Rehabilitation is accompanied by wearing optimal shoes and custom-made orthopedic insoles. High-heeled shoes are excluded due to excessive pressure on the toes and the front of the foot, and, accordingly, on the site of injury. Periodically, such fractures lead to the detachment of pieces of the bone body and their displacement, damage to the Lisfranc joint. Then surgical intervention is indicated.
What is a stress fracture
Let's say you run a lot and don't recover well. Over time, tired muscles will no longer be able to absorb the shock load and will transfer it to the bones. Repeated stress causes microdamage to the bone, and if you add neglect of recovery and ignoring the symptoms of injury, then gradually these damages will become more noticeable and more serious. What happens next is called a stress fracture.
According to orthopedic surgeons, the second and third metatarsal bones of the foot are more susceptible to stress fractures than other bones. The area where they are located is most involved in running. She is responsible for repulsion.
Read on the topic: Inflammation of the periosteum: how to treat and how not to get it
Complications[edit | edit code]
The first of the possible diagnoses is to exclude a stress fracture of the femoral neck, since if this fracture is missed, the consequences can be most severe. Without proper treatment, it can develop into a complete fracture of the femoral neck, which is much more difficult to treat and may require open reduction of the fragments with internal osteosynthesis. Possible complications of a complete fracture of the femoral neck include delayed healing, nonunion, and avascular necrosis of the femoral head, the treatment of which may require femoral osteotomy or hip replacement, that is, operations after which it will be almost impossible to return to sports.
Area of injury
Stress fractures can affect the heel, the ankle, the midfoot, and even the pelvis, sacrum: in general, all those areas that are exposed to impacts, and the muscles, due to fatigue, cannot absorb them. But runners most often suffer from the bones of the lower leg or foot, because they are the ones that work the hardest for this sport. We are talking about load-bearing bones - the tibia and metatarsals.
Stress fractures of the leg and foot can be successfully treated, and if the fracture occurs on very strong bones of the pelvis or hip, this indicates health problems much more serious than a sharp increase in load and insufficient recovery.
What Causes a Stress Fracture
In simple terms, this injury is caused by insufficient recovery. Have you all heard about the golden rule of 10% increase in training loads? All this is not just like that, since both muscles and bones must get used to the load in order to be able to digest it. And it's not just about the mileage on your watch.
Stress fractures are typically the result of not only unusually high volume, but also a sudden increase in intensity when the body does not have enough time to adapt. In this case, the bone will simply exhaust all its resources for restoration.
Winter is the period when the risk of developing a stress fracture is greatest. Cause: Vitamin D deficiency. So remember that as an active person, you need higher levels of vitamin D than everyone else.
What else could put a runner at risk? Low calcium levels coupled with high caffeine intake flushes it out of the body. In addition, research shows that women with a low body mass index and older runners, whose bone density decreases as they age, are particularly at risk.
How to get back to running and exercising
So, after 8 weeks of rest from the impact of running, your muscles and bones have recovered. How to train? Of course, forget about previous volumes and do not try to update all your personal records. Exercise should be resumed gradually and stopped if you feel pain. Ignoring these simple recommendations increases the likelihood of a recurrent fracture.
During your gradual return to exercise, wear compression gaiters, a brace, or a support boot, depending on the location of the injury. They will take the pressure off the weakened area. For your running shoes, purchase special inserts or orthotics for better shock absorption.
Read more: 9 simple exercises to strengthen your feet
Trauma Diagnosis Options
Diagnosis can be difficult in the early stages, since there are no clear manifestations of the fracture on x-rays. However, you can resort to more accurate diagnostic methods or perform several tests at home before going to the doctor.
Self-diagnosis
Jump test
A stress fracture is clearly identified by the jump test. Just jump on each leg one at a time. Typically, a sharp pain pierces the site of a stress fracture. It may radiate along the bone.
Tuning fork test
Another distinctive symptom is that if you apply a tuning fork to the fracture site, the vibration will cause acute local pain.
Other signs
In addition, the pain is intensified by tapping several fingers on the bone and pressing on the affected area.
Medical diagnosis
It is important for you to remember: self-diagnosis does not replace going to the doctor.
We have already discussed X-ray diagnostics.
Scintigraphy is better at identifying stress fractures, but is a low-specific method. This means that a lesion can be detected, but it is difficult to say for sure that it is a fracture.
The ideal research method is magnetic resonance imaging (MRI). It allows you to determine the location and depth of the fracture, assess the condition of the bone + surrounding tissues.
The signs of a fracture are the same as for x-rays: sclerosis, cortical hypertrophy. At the conclusion of an MRI examination, you may come across the words: bone edema/focus bone marrow edema/focus periosteal edema.
This highly sensitive method allows you to detect a fracture at an early stage, which is called a stress reaction.
Mechanism of injury formation
The running process is associated with 2 types of load: shock + pushing (active).
Impact = landing on the foot. It is transmitted along the kinetic chain: foot - ankle - lower leg - knee - thigh - hip joint - pelvis - spine. The impact is partially “absorbed” at the level of the foot due to shock absorption + the load is partially absorbed by the muscles involved in the running process. However, some situations make it difficult to “dampen” this shock load. The bones begin to get injured.
A stress fracture is a stress fracture of a bone due to repeated, increased stress. The injury is of the “overuse” type - excessive use of tissue.
There is no fracture as such (violation of the external integrity of the bone). An internal “bruise, swelling” of the bone occurs, and a violation of the tissue structure is formed.
Over time, if the load is not removed, the bone will continue to deteriorate. The result can really be sad - an actual fracture with a long recovery period.
What factors can cause stress fractures?
Recovery after surgery
Recovery after surgery for a displaced fracture involves returning the bone to its original state. After a fracture, rehabilitators are engaged in eliminating the negative factors that appear as a result of fusion of bones and wearing a cast. You should be especially careful during this period! Over the course of several months, the muscles atrophied, some changes occurred in the blood vessels, muscle tone and elasticity were lost, and swelling appeared.
Medical massages and therapeutic exercises will be useful. It is not recommended to do exercise therapy on your own, since without the supervision of a doctor you may not only not improve the situation, but also do harm. The load should increase very slowly and gradually, and the set of exercises should be selected strictly on an individual basis, taking into account the characteristics of a particular patient. When drawing up a rehabilitation program, the patient’s condition, the level of severity of the injury suffered, and the peculiarities of the recovery process are taken into account.
Prevention[edit | edit code]
Several factors predispose to stress fractures, which can be divided into extrinsic and intrinsic: extrinsic factors include footwear, playing field or track surfaces, and intensity of exercise, and intrinsic factors include osteopenia and various disorders of normal skeletal anatomy, such as varus deformity of the femoral neck. All these factors must be taken into account to prevent stress fractures. Thus, long-distance runners are better off wearing shoes with soft, elastic soles and running on a surface that is not too hard. In addition, gradually, rather than suddenly, increasing the load during training reduces the likelihood of any stress fractures.
Internal predisposing factors are more difficult to influence. Anatomical defects can be corrected using orthopedic devices. Osteopenia is more common in women and is part of the so-called triad of female athletes (including, in addition to osteopenia, an eating disorder and amenorrhea). It requires more active intervention from a doctor and the prescription of medications and a special diet.