|
Year |
2005 |
|---|---|
|
Question Number |
226. |
|
Category |
Foot and Ankle |
Question
What is the most common location for stress fractures of the foot in ballet dancers?
1 – navicular
2 – medial sesamoid
3 – first metatarsal base
4 – second metatarsal base
5 – second metatarsal neck
Figures
Answer (click for answer)
Answer: 4
This is one of those you just memorize.
Stress fractures are a frequent injury in ballet dancers, most commonly at the base of the second metatarsal. The clinical presentation involves the insidious onset of midfoot pain. The initial radiographs are often negative. The stress fracture typically occurs at the proximal metaphyseal-diaphyseal junction and can extend into the tarsometatarsal (Lisfranc) joint. Stress fractures at the base of the second metatarsal are usually treated conservatively with either a hard-soled shoe or a short leg walking cast.
The article from O’Malley and Hamilton summed it up fairly well: Stress fractures are a frequent injury in ballet companies and the most common location is at the base of the second metatarsal. History of a previous stress fracture in the lower extremity was seen in 19 patients and delayed menarche in the women was common. The clinical presentation was insidious onset of midfoot pain an average of 2.5 weeks prior to seeking medical care. The initial radiographs of the foot were positive in 19 patients, questionable in 3 patients, and negative in 42 patients. The usual location of the fracture was at the proximal metaphyseal-diaphyseal junction (three fractures extended into the tarsometatarsal joint). Treatment consisted of a short leg walking cast for 6 patients, and a wooden shoe and symptomatic treatment for the remainder. At follow-up, 14% of patients still had occasional pain or stiffness in the midfoot with dancing. The patients returned to performance at an average of 6.2 weeks following diagnosis. No patients required bone grafting for persistent symptoms. There were eight refractures (at the same site) occurring an average of 4.3 years, all of which healed with conservative care. Stress fractures at the base of the second metatarsal are common in ballet dancers and can usually be treated with symptomatically
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