Marching foot (Deichlander's disease) belongs to a group of diseases that are caused by pathological restructuring of bones. The pathological process develops, as a rule, in the 2nd metatarsal bone, less often in the 3rd, and even more rarely in the 4th or 5th. For the 1st metatarsal bone, such a disease is not typical at all. In many patients, the process of bone structure restructuring affects only one metatarsal bone. In some cases, orthopedists and traumatologists observe the involvement of several bones in the pathological process, first on one foot and then on the other.
Causes
- Marching foot often occurs in young soldiers after long marches;
- Occurs in people who wear very narrow and uncomfortable shoes;
- People with flat feet are most prone to this disease;
- Professional athletes (long-term physical activity, artistic gymnastics);
- Occupational disease among ballet workers;
- Prolonged standing position of a person (hairdresser, operating surgeon);
- This disease often occurs in people whose profession involves prolonged walking or heavy lifting.
What is it, ICD 10 code and mechanism of development of Deichlander's disease
If we consider the nature of the marching foot, we can find that it has nothing in common with inflammatory diseases or a tumor process.
Pathophysiological processes in bones occur under the influence of various factors, for example, changes in mechanical and static-dynamic functions as a result of physical overload of the foot. If you examine the affected bone under a microscope, you can see that in some places of the metatarsal bone tissue has been reabsorbed and replaced by new normal bone structures.
Several years ago, in traumatology, the march foot was considered an occult fracture, and it had various names - “incomplete metatarsal fracture” or “microfractures of the metatarsal bone.” Thus, the names “marching fracture” and “recruit fracture” have no basis and have been preserved historically.
The pathology is not inflammatory or malignant. Marching fracture of the foot (code M84.4 according to ICD-10) can occur acutely or chronically.
The pathogenesis of the disease is associated with excessive stress on the legs. The human feet are responsible for support and shock absorption during movement. In untrained people, the bones cannot cope with an unusual load. Pathological changes are formed in the diaphyseal part of the metatarsus. The process may involve the II, III, rarely - IV, V metatarsal bones.
Pathological changes in bone tissue are represented by lacunar resorption. Over time, the affected area is replaced by new cells. The pathological process disappears.
The opinion of professors of medicine on the name of pathological changes is divided. Some believe that an incomplete fracture is formed. Others call the changes a microfracture. Most doctors agree that the name “marching fracture” is outdated. Bone resorption occurs locally, and over time it is independently replaced by bone tissue without complications. The disease is less common among soldiers. Widely distributed among hairdressers and fashion models. They wear huge heels and are on the move all day.
What it is
There are two points of view on the nature of this damage. Some experts believe that a so-called fracture, or microfracture, occurs in the bone tissue. Others adhere to more modern views and talk about the origin of the changes as a consequence of partial resorption of the bone and its subsequent replacement by a new structure without the formation of callus.
Thus, a march fracture is the result of complex neurodystrophic and muscular disorders, accompanied by impaired blood and lymph flow, as well as intraosseous metabolism.
A marching foot is essentially a stress fracture, which is caused by the breakdown of bone due to repeated stress. It appears as a result of accumulated microtraumas against the background of cyclic loads, which in themselves do not exceed the strength of the bone, but with constant exposure lead to characteristic damage.
A common traumatic fracture occurs from a single blow that exceeds the bone's ultimate strength. Fatigue or stress fractures provoke regular overload and overtraining of individual parts of the body.
Note: stress fractures mainly affect the bones of the lower extremities.
A marching metatarsal fracture is one of the typical injuries in the category of stress fractures, along with damage to the navicular and tibia bones of the legs. Stress fractures of the hip, pelvis and sacrum are much less common.
Pathogenesis
The metatarsus is the middle part of the foot. It is located between the tarsal bone and the fingers. This section of the lower limb consists of five bones and experiences the greatest load when standing and walking.
With Deutschlander's disease, restructuring and partial resorption of bone tissue occurs. The second and third metatarsal bones are usually affected, as they bear the heaviest load. On an x-ray, the changes appear as if one part of the bone has partially separated from another. Therefore, the disease is often called a march fracture.
However, this pathology does not result from trauma. It does not completely tear off the bone. This disease is only superficially similar to an incomplete fracture. Over time, the affected areas are covered with normal bone tissue. Therefore, many experts consider the term march fracture obsolete.
X-ray changes in this pathology can be seen in the photo below.
In Deichlander's disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. The pathological reorganization of bone tissue in this case is due to changed mechanical and static-dynamic factors. The process most often involves the second metatarsal bone, less often the third, and even less often the fourth and fifth.
Usually one bone is affected, although it is possible for several bones in one or both feet to be affected simultaneously or sequentially. It has been established that marching foot is a special type of bone tissue transformation that is not associated with tumor or inflammation.
At the same time, the views of specialists on the nature of the damage are still divided. Some believe that bone remodeling is accompanied by an incomplete fracture or a so-called “microfracture.” Others believe that the term “marching fracture” should be considered outdated and untrue, since only local resorption of bone tissue occurs, which is subsequently replaced by normal bone without the formation of a callus.
What happens if you don't get treatment?
If left untreated, marching foot can be complicated by significant bone growth and enlargement in areas near the base of the toes. Over time, the pathological process involves not only bone tissue, but also surrounding nerves, which will contribute to increased pain.
Another consequence of untreated Deichlander's disease may be the progression of focal osteoporosis and a predisposition to spontaneous fractures that occur even from a small blow or gentle push.
Osteoporosis is an initially asymptomatic, but very insidious disease, the progression of which leads to increased fragility and fragility of bones.
One of the consequences of marching foot is deforming osteoarthritis, which is most often discovered in old age. Deformation in the area of the arches of the feet distorts the functioning of the articular-ligamentous apparatus, and the cartilage wears out faster. Unlike a march fracture, arthrosis is an incurable disease, which is much more difficult to cope with.
Causes and symptoms of marching foot
Pathological reorganization of bones in Deichlander's disease occurs under the influence of provoking factors.
According to medical statistics, common causes of the disease are:
- strong physical activity ensures the development of pathology in untrained people;
- walking long distances in uncomfortable shoes;
- lack of physical fitness;
- pathology occurs in recruits after a field march, or less often a drill march;
- congenital/acquired deformities of the foot can provoke the development of a marching fracture.
The risk group for developing the disease includes people in the following professions:
- salespeople, consultants in hypermarkets;
- stylists, hairdressers;
- tour guides;
- general workers;
- models, athletes;
- health workers;
- waiters;
- figure skaters.
Tight high-heeled shoes, flat feet, and walking long distances provoke the development of marching foot.
According to the international classification, there are two forms of pathology:
- Acute - characterized by a sudden onset. On days 3-4 we observe the appearance of the first symptoms of marching foot. Patients complain of acute pain in the middle of the foot and severe swelling in the area of the pathology. The disease is not accompanied by fever or asthenovegetative syndrome (weakness, loss of appetite).
- The primary chronic form of marching foot is characterized by a slow progression. After significant exertion, patients report intense pain in the central part of the sole, swelling, swelling, and redness. The sensitivity of the skin at the site of the lesion increases. Due to severe pain, gait is impaired. The man begins to limp. The disease lasts for several months, then gradually the symptoms disappear.
- 2 weeks from the onset of pain in the diaphysis of the second metatarsal bone, a thin line resembling a fracture (“marching”);
— after 2 months, the diaphysis is thickened due to periosteal layers at the level of the transverse zone of reconstruction.
Deutschlander's disease was first described in 1885 in soldiers who had made a long march, and therefore received the name “marching foot”, and later - in the era of radiology - “marching fracture”. This disease still occurs in soldiers, tourists, athletes after improper dosing of loads, as well as in women after changing shoes and increased stress on the legs.
Deutschlander's disease begins with pain when walking in the rear of the marching foot, swelling and lameness.
Diagnostics
The diagnosis is made based on:
- The patient complains of pain with a specific localization.
- History of the disease: the first symptoms of the pathology appeared against the background of an unusual load.
- Life history (the patient works in an area with intense physical activity on the legs).
- Objective examination of the site of injury: upon palpation of the midfoot, the patient complains of sharp pain. On examination, swelling, swelling, and redness are observed.
- An x-ray of the foot helps to definitively confirm the diagnosis. The research method reveals typical signs of Deichlander's disease, excludes osteomyelitis, tuberculosis, malignant tumor, purulent bone processes.
The X-ray picture depends on the duration of the disease. Main manifestations of pathology:
- If the picture is taken a few days after the onset of the disease, pathological changes may not be observed. It is recommended to repeat the study in a week. An alternative option is to get an MRI.
- With a marching fracture, an oblique or transverse band of clearing is observed. The phenomenon is called the Looser zone. The metatarsal appears to be split into two pieces. If a person breaks a bone, there is deformation and displacement. The disease does not have the listed phenomena.
- Over time, periosteal growths appear around the pathological area. They are represented by thin formations and begin to gradually become denser. The photo resembles a fusiform callus. After a few weeks, the clearing zone completely disappears. Sclerosis of the affected area occurs.
- Periosteal layers dissolve. The structure of the metatarsal bone is permanently changed. Becomes thick and dense.
Radiography helps distinguish a march fracture from other traumatic injuries. With pathology, the correct shape of the metatarsus is maintained, there is no displacement of fragments, or an area of inflammation.
Risk group
The disease most often develops in patients with flat feet. Also at risk are people whose activities involve increased stress on their legs:
- recruit soldiers;
- tourists;
- athletes;
- dancers;
- tour guides;
- waiters;
- hairdressers.
Wearing uncomfortable shoes can provoke Deutschlander's disease. Pathological changes in the metatarsal bones are often observed in women wearing high-heeled shoes.
This disease often develops in untrained people. In a person who is not accustomed to intense physical activity, pathology can occur even after systematic long walks.
Treatment methods
Treatment of marching foot begins with diagnostic measures (X-ray, MRI). After confirmation of the diagnosis, conservative therapy is started:
- Doctors prescribe bed rest to the patient.
- It is prohibited to put intense stress on the legs. You cannot stand or walk for a long time.
- Plaster splints are fitted to restore the integrity of the feet.
- The patient should go to therapeutic exercises and massage.
- Physiotherapy is prescribed to relieve typical symptoms of the disease.
- Medications are used to reduce the symptoms of pain. Painkillers, cooling ointments, and topical balms are prescribed.
- You should wear orthopedic shoes and special insoles for a long time to prevent complications.
Surgical methods of treatment for pathology are not used. The microfracture heals on its own.
The disease is being treated in the traumatology department. In acute cases, traumatologists apply a plaster splint for 10 days. The medical device helps restore the physiological structure of the bone. The splint provides rest to the affected limbs.
Primary chronic marching foot is treated with massages and physiotherapy.
In an inpatient setting, to relieve pain, the patient is prescribed:
- Ketorolac fights pain and inflammation. The medicine inhibits the activity of COX-1, COX-2. The latter are responsible for the synthesis of prostaglandins. Inflammatory mediators are not formed and unpleasant symptoms disappear. Ketorolac does not affect sleep and breathing, and copes with pain better than many NSAIDs. Prescribed 10 mg up to 4 times a day. The drug is taken under the supervision of a doctor.
- Metamizole sodium (analgin) has similar effects. Used to relieve pain of various origins. The medicine should be taken 1-2 tablets 2-3 times a day after meals.
- Additionally, calcium supplements are prescribed. The macroelement helps to quickly strengthen the metatarsal bone.
After discharge, the patient should use orthopedic shoes and avoid excessive stress.
Unlike a real fracture, Deutschlander's disease does not require a cast. However, it is necessary to temporarily limit the load on the legs.
The patient is advised to remain in bed for 8-10 days. A splint is placed on the affected limb for a period of 1 month. This provides rest to the leg and promotes rapid healing of the injury.
For severe pain, analgesic ointments and gels are prescribed:
- “Troxevasin”;
- “Gevkamen”;
- “Efkamon”;
- “Bom-benge”;
- “Boromenthol.”
The use of warming local agents is not recommended. In this case, they aggravate the discomfort.
After removing the splint bandage, the patient is prescribed a course of physiotherapy. Massage, warm foot baths, and paraffin applications on the metatarsal area are indicated. In the future, patients are advised to use shoe insoles and avoid excessive stress on the lower extremities.
Treatment
Deuchlander's disease is treated conservatively. The principles of therapy are based on eliminating the pathogenetic mechanism that caused the disease. Surgery is not indicated for such patients . The term of conservative treatment of the patient covers the entire period of bone remodeling.
The patient is prescribed special orthopedic insoles. He is freed from prolonged standing or walking; the foot must be given rest and unloading done.
Physiotherapy and massage are prescribed at the clinic. Applications with ozokerite and paraffin, as well as electrotherapy, have a good effect. When treating Deichlander's disease, you can use warming ointments, for example, Fastum-gel. At home, the patient is recommended to make warm foot baths with sea salt or medicinal herbs.
A patient with marching foot is prescribed static gymnastics, which is aimed at relaxing the lower leg muscles.
Symptoms
The acute form of the disease develops 3-4 days after heavy load on the legs (for example, a long hike or forced march). The patient has pain in the foot and swelling above the metatarsal bones. The discomfort can be quite intense.
The primary chronic form of the disease is more common. Symptoms of bone damage increase gradually. At first, the pain is mild and does not interfere with movement. The patient often wonders why his foot hurts, because he has not had any injuries.
Over time, the pain becomes intense and unbearable. The patient begins to limp severely. A person tries to step on the injured limb as little as possible due to pain in the foot. The swelling on top of the metatarsus looks like a dense edema. There is pain when pressing on it.
Very rarely, slight redness of the skin is observed in the area of edema. At the same time, the patient’s general well-being is not impaired, there is no high temperature or weakness.
Such symptoms may bother the patient for 3-4 months. Then the pain subsides, and the pathology ends with recovery. The changed areas of the metatarsus are covered with normal bone tissue. We can say that this disease always ends on its own and does not cause complications. However, you should not neglect therapy. The pain associated with this pathology can be very severe. Often the patient cannot move normally due to discomfort.
Symptoms
- A person suddenly develops severe pain when walking, which is localized in the middle part of the foot;
- Uncertain gait;
- Lameness for several weeks or months;
- When examining the dorsum of the foot, attention is drawn to the fact that a vaguely defined hard swelling has appeared above the diaphysis of the metatarsal bone affected by the pathological process;
- The soft tissues of the dorsum of the foot are swollen;
- Very rarely there is hyperemia (redness) of the skin over the site of injury;
- The skin over the affected metatarsal bone is sensitive;
- There are no general reactions of the body in the form of increased body temperature, malaise or drowsiness;
- Biochemical blood test values are within normal limits.
Prevention
We can conclude that this disease is easily curable and does not cause complications. However, it significantly reduces the patient's quality of life. Therefore, it is necessary to take measures to prevent pathology.
If a person’s activity involves stress on the legs, then it is necessary to periodically undergo a course of therapeutic massage. At home, it is useful to do foot baths after a working day. For long walks, you should wear comfortable low-heeled shoes. Newly recruited soldiers should be examined regularly by an orthopedic surgeon. This will help avoid damage to the metatarsal bones.
- Timely diagnosis and treatment of functional foot deficiency;
- Wearing orthopedic insoles and arch supports;
- Wearing comfortable shoes;
- Avoiding periods of long walking;
- Avoiding periods of prolonged standing;
- Medical examinations (athletes, artists, pre-conscription personnel);
- Career guidance (recommendations from an orthopedist when choosing a profession).
Traditional methods
The collection of folk recipes is full of remedies used in the complex treatment of bruises, sprains and fractures of varying severity. They speed up the healing process and relieve painful symptoms.
Traditional medicine experts recommend eating 2 walnuts daily to keep your bones and joints strong. They also advise making a potion from the film extracted from eggshells and lemon juice. The film is pre-crushed and mixed with a small amount of juice. Take the drug orally until symptoms disappear.
You can also prepare a compress from egg yolk with half a teaspoon of salt. The ingredients are mixed and distributed on a napkin or bandage, which is applied to the leg. The compress should be tied with a bandage, preferably elastic, so that it does not fall off, and kept on all day.
For oral administration, prepare a decoction of herbs that have a sedative effect - chamomile, valerian and St. John's wort. Take a glass of boiling water per tablespoon of the mixture; after infusing for an hour, the medicine is taken three times a day in a single dose of 1/3 glass.
A decoction of horsetail is also made. 1 tbsp. l. herbs are poured with a glass of hot water and infused for half an hour. Drink a third of a glass of the decoction three times a day.
Rosehip infusion is one of the best restoratives, indispensable for most diseases. It is preferable to cook it in a thermos, taking 2 tbsp. l. fruits per 2 liters of water. Combine rose hips and boiling water, close the thermos with a tight lid and leave for at least 6 hours. Then take the infusion half a glass up to 5 times a day. To improve the taste and enhance the therapeutic effect, it is not forbidden to add honey.
The popularity of rosehip infusion is due not only to its medicinal properties and pleasant taste, but also to its accessibility and ease of preparation.
The next remedy can be prepared at the beginning of summer, when cornflowers bloom. Grind several flowers and take about 2 tbsp. l., mixed with a glass of sloe juice. Take 2 tbsp. l. before breakfast, during the week.