Metatarsal Stress Fracture 733.94

synonyms:

Metatarsal Stress Fracture ICD-9

• 733.94( stress fracture of metatarsals)

Metatarsal Stress Fracture Etiology / Epidemiology / Natural History

• Second metatarsal stress fracture is most common.  5th metatarsal is least common.
• Associated with: rapidly increasing the amount or intensity of exercise or heavy work too rapidly, activity on hard/unfamiliar surface, inappropriate/worn out shoes, 
• Common in long distance runners and women age 50-70.

Metatarsal Stress Fracture Anatomy

• Metatarsal stress fractures have been associated with Cavus foot deformity

Metatarsal Stress Fracture Clinical Evaluation

• Gradually worsening pain in the foot.  Often presents after a nagging long term pain in the foot becomes much more severe.
• Identify and correct any predisposing factors. Hormonal, nutritional and medical abnomralities should be identified and treated.

Metatarsal Stress Fracture Xray / Diagnositc Tests

• AP, lateral and oblique views of the foot generally indicated.  Often are normal.  May not be evident until several months after symptoms begin.  May demonstrate cortical thickening in the area of the fracture.  Cortical thickening indicates a healing stress injury.
• Bone scan: high sensitivity and will be positive within a few days of the start of symptoms.
• MRI is as senstive and is more specific than bone scan.
• Ultrasound may be useful in experienced hands. (Banal F, J Rheumatology 2009;36:1715)

Metatarsal Stress Fracture Classification / Treatment

• Initial treatment: avoid running or painful activity for 6-8 weeks.  Generally place in hard-soled shoe, WBAT.  May very gradually return to activity when completely pain/symptom free.  Consider walker boot, crutches, minimize weight bearing depending on severity of fracture.
• Delayed union: callus visible on xray, but no healing.  Continue hard soled shoe or walker boot and minimize weight bearing.  Consider bone stimulator. 
• 5th metatarsal stress fracture Nonunion with 
• Nonunion 5th Metatarsal Zone 3 ; Diaphyseal Stress Fracture with neutral heel: Treatment = intrameduallary screw fixation.
• Nonunion 5th Metatarsal Zone 3; Diaphyseal Stress Fracture with flexible cavovarus heel: Treatment =intrameduallary screw fixation of the 5th metatarsal with dorsiflexion osteotomy of the 1st metatarsal (DenHartog BD, JAAOS 2009;17:458).

Metatarsal Stress Fracture Associated Injuries / Differential Diagnosis

Metatarsal Stress Fracture Complications

Metatarsal Stress Fracture Follow-up Care

Metatarsal Stress Fracture Review References

• Boden BP, JAAOS 2000;8:344
• Kennedy JG, Intl Sport Med J 2006;7:85
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