DOCSLIB.ORG

Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History I Matsuda et al. Sports Medicine - Open (2017) 3:27 DOI 10.1186/s40798-017-0095-y ORIGINAL RESEARCH ARTICLE Open Access Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study Sho Matsuda1* , Toru Fukubayashi2 and Norikazu Hirose2 Abstract Background: There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. Methods: The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg–heel alignment, non-weight-bearing leg–heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure. Results: The non-weight-bearing leg–heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P =0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P < 0.05). There were no significant differences in the frequency of fifth metatarsal stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. Conclusions: Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future. Key Points Midfield players had significantly higher rates of fifth metatarsal stress fracture, whereas defenders had The results of the present study suggest that an everted significantly lower rates. rearfoot and inverted forefoot alignment are associated with a history of fifth metatarsal stress fracture. Plantar pressure did not differ between the fifth Background metatarsal stress fracture group and the control A fifth metatarsal stress fracture (MT-5 fracture) is a group. common injury in soccer players. In fact, a previous in- vestigation of a European soccer league found that 78% of stress fractures occurring in professional soccer players involved the fifth metatarsal bone. The incidence * Correspondence: [email protected] was 0.037–0.04/1000 exposure hours [1, 2] and 0.10– 1 Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, 0.12/1000 athlete exposures in Japan [3]. Tokorozawa Saitama 359-1192, Japan Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Matsuda et al. Sports Medicine - Open (2017) 3:27 Page 2 of 7 The MT-5 fracture is well known and requires a long informed of the procedures and the purpose of this study period to recover from [4–14]. Moreover, MT-5 frac- andprovidedwritteninformedconsent.Theparticipants tures may not achieve union because of poor blood flow were free to withdraw from participation at any time with- around the injured region (the proximal diaphysis) [15]. out fear of consequences. For instance, surgical treatment requires a shorter period The participants comprised 335 collegiate male soccer (15.2 ± 10.5 weeks) before regaining the ability to play players from Kanto University Football Association (a than conservative treatment (26.3 ± 11.0 weeks) [16]. level equivalent to NCAA Division 1 or 2). All partici- Therefore, occasional surgical treatment is recom- pants were able to participate in full training sessions mended for athletes [7, 11, 13, 16–18]. However, even if with no pain for at least 1 year. Using the results of a the MT-5 fracture is treated surgically, it takes at least questionnaire, they were divided into two groups: 29 in 3–8 months before the individual can play sports again. the fracture group (28 unilateral and 1 bilateral) with a Therefore, this injury has a negative impact on per- history of MT-5 stress fractures diagnosed by an ortho- formance, and prevention of its occurrence is important. pedic surgeon and 306 in the control group (Table 1). In Moreover, MT-5 fractures are well known for their addition, 29 fracture group players were subdivided into high recurrence rate [14]. The MT-5 fracture recurrence the fracture foot (FF) group (30 feet), non-fracture foot rate is 25%, which is much higher than that of hamstring (NF) group (28 feet), and control foot (CF; the mean strains (13%) [19] or ankle sprains (10.3%) [20]. There- values of bilateral feet data) group (306 players). fore, in addition to preventing the initial injury, it is important to prevent injury recurrence. Measurements and Procedures The foot length, arch height, weight-bearing leg–heel As van Mechelen et al. proposed, identifying the alignment (W-LHA: same as resting calcaneal stance mechanism and risk factors of the targeted injury position), non-weight-bearing leg–heel alignment (N- is necessary for preventing injury [21]. A previous LHA), forefoot angle relative to the rearfoot (FA-R), retrospective study suggested that an inverted rearfoot, forefoot angle relative to the horizontal axis (FA-H), and which can be examined using radiographs, is a risk foot pressure were measured. All measurements were factor for MT-5 fracture [10, 22]. However, this taken by the same physical therapist and were obtained screening procedure is difficult to generalize before the soccer season (February to March). In because X-ray assessment requires specific locations, addition, the participant’s dominant foot, history of ankle equipment, and skilled technicians in the field. To sprain, ankle sprain severity, and playing position were resolve this issue, easier, alternative protocols for obtained using a questionnaire. evaluating risk factors of MT-5 fractures, such as high medial longitudinal arch height [23]andplantar Arch Ratio pressure [24] have been proposed. However, no The selected method to measure arch height (the bony consensus regarding risk factors for MT-5 fractures arch index) was the anthropometric technique described has been established because of a lack of studies by Cowan. The foot length (back of the heel to the tip of with large numbers of subjects. the toe) and navicular height were measured using a ruler [25]. The arch ratio was defined as the arch height This study aimed to identify the possible risk factors divided by the foot length. The intraclass coefficient for recurrence of MT-5 fractures. To clarify this issue, (ICC) values were 0.94 for intrarater reliability and 0.89 we compared the static foot alignment and distribution for interrater reliability. of foot pressure during leg calf raise exercises of players with a history of MT-5 fractures with those of healthy Rearfoot and Forefoot Alignment [26–28] players. The calf raise task demonstrates loading on the Rearfoot and forefoot alignment evaluations were per- forefoot. Danahue et al. reported that peak fifth metatar- formed as described by Gross et al., and the ICC for sal strain was 80% through the stance of walking (during intrarater reliability was 0.91 for the forefoot and 0.87 forefoot loading). It has been hypothesized that players for the rearfoot [26]. We marked two points on the cen- with a history of MT-5 fractures exhibit rearfoot inver- terline of the calcaneus at the distal and proximal re- sion alignment and that their foot pressure is biased to gions and calculated two points on the centerline of the the lateral region of the foot. Table 1 Study subject characteristics Methods N Height (cm) Age (years) Weight (kg) All study protocols were approved by the Ethics Committee Without fracture history 306 173.5 ± 9.9 20.1 ± 1.1 67.9 ± 6.8 on Human Research of the university. This study conforms With fracture history 29 172.8 ± 5.8 20.0 ± 1.1 67.5 ± 7.0 to the Declaration of Helsinki. All subjects were fully Data are presented as the mean ± standard deviation Matsuda et al. Sports Medicine - Open (2017) 3:27 Page 3 of 7 Fig. 3 Left: measurement of FA-R. Right: measurement of FA-H. FA-R: the angle between a line perpendicular to the calcaneal bone axis and a line from the thenar to the hypothenar. FA-H: the angle between the horizontal axis and a line from the thenar to the hypothenar Fig. 1 Measurement of W-LHA. Subjects were placed in the weight- bearing position and we measured the angle between the lower leg line and calcaneus line using imageJ leg and Achilles tendon. Subjects were placed in the weight-bearing position (standing) and non-weight- bearing position (prone) with the hips, knees, and ankles neutral, and photographs were taken from the posterior of the feet (Figs. 1 and 2). A photograph was also taken of all participants’ lower legs and calcanei from the pos- terior side.
Load more

Recommended publications
  • 5Th Metatarsal Fracture
    FIFTH METATARSAL FRACTURES Todd Gothelf MD (USA), FRACS, FAAOS, Dip. ABOS Foot, Ankle, Shoulder Surgeon Orthopaedic You have been diagnosed with a fracture of the fifth metatarsal bone. Surgeons This tyPe of fracture usually occurs when the ankle suddenly rolls inward. When the ankle rolls, a tendon that is attached to the fifth metatarsal bone is J. Goldberg stretched. Because the bone is weaker than the tendon, the bone cracks first. A. Turnbull R. Pattinson A. Loefler All bones heal in a different way when they break. This is esPecially true J. Negrine of the fifth metatarsal bone. In addition, the blood suPPly varies to different I. PoPoff areas, making it a lot harder for some fractures to heal without helP. Below are D. Sher descriPtions of the main Patterns of fractures of the fifth metatarsal fractures T. Gothelf and treatments for each. Sports Physicians FIFTH METATARSAL AVULSION FRACTURE J. Best This fracture Pattern occurs at the tiP of the bone (figure 1). These M. Cusi fractures have a very high rate of healing and require little Protection. Weight P. Annett on the foot is allowed as soon as the Patient is comfortable. While crutches may helP initially, walking without them is allowed. I Prefer to Place Patients in a walking boot, as it allows for more comfortable walking and Protects the foot from further injury. RICE treatment is initiated. Pain should be exPected to diminish over the first four weeks, but may not comPletely go away for several months. Follow-uP radiographs are not necessary if the Pain resolves as exPected.
    [Show full text]
  • ASSESSMENT of FIFTH METATARSAL ETIOLOGY Daniel Reed Clemson University, [email protected]
    Clemson University TigerPrints All Theses Theses 7-2008 ASSESSMENT OF FIFTH METATARSAL ETIOLOGY Daniel Reed Clemson University, [email protected] Follow this and additional works at: https://tigerprints.clemson.edu/all_theses Part of the Biomedical Engineering and Bioengineering Commons Recommended Citation Reed, Daniel, "ASSESSMENT OF FIFTH METATARSAL ETIOLOGY" (2008). All Theses. 428. https://tigerprints.clemson.edu/all_theses/428 This Thesis is brought to you for free and open access by the Theses at TigerPrints. It has been accepted for inclusion in All Theses by an authorized administrator of TigerPrints. For more information, please contact [email protected]. ASSESSMENT OF FIFTH METATARSAL FRACTURE ETIOLOGY A Thesis Presented to the Graduate School of Clemson University In Partial Fulfillment of the Requirement for the Degree Master of Science Bioengineering by Daniel Reed August 2008 Accepted by: Dr. Martine Laberge, Committee Chair Dr. Lisa Benson Dr. Larry Bowman MD ABSTRACT The fifth metatarsal “Jones Fracture” is a fracture that occurs 3.5cm distal to the tuberosity. It is an injury that is common in athletes, especially those who participate in sports with a lot of lateral movement. The Jones Fracture is known for its difficulty to heal due to non-union and re-fracture. There has been much research recently regarding in-shoe pressure distributions and their relation to shoe type, movement, and shoe surface interaction. However, only the forces along the bottom of the foot have been investigated. Literature and the direction of fracture seem to implicate a force on the lateral portion of the foot is the cause of the fracture though the exact causal forces are still largely unknown.
    [Show full text]
  • Case Report: Atypical Metatarsal Fracture in a Patient on Long- Term Bisphosphonate Therapy
    November 2019. Volume 6. Number 4 Case Report: ATypical Metatarsal Fracture in a Patient on Long- Term Bisphosphonate Therapy Bijan Valiollahi1 , Mostafa Salehpour1 , Hamidreza Bashari1 , Shoeib Majdi1 , Mehdi Mohammadpour1 * 1. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran. Use your device to scan and read the article online Citation Valiollahi B, Salehpour M, Bashari H, Majdi Sh, Mohammadpour M. ATypical Metatarsal Fracture in a Patient on Long-Term Bisphosphonate Therapy. Journal of Research in Orthopedic Science. 2019; 6(4):25-30. http://dx.doi.org/10.32598/ JROSJ.6.4.67 : http://dx.doi.org/10.32598/JROSJ.6.4.67 A B S T R A C T Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment Article info: of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the Received: 13 May 2019 long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft Revised: 27 May 2019 fractures but also pathological fractures at other musculoskeletal sites. This report presents a Accepted: 16 Sep 2019 rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a Available Online: 01 Nov 2019 history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur). Keywords: Alendronate, Pathologic Fracture, Metatarsal 1. Introduction ally, drugs such as bisphosphonates contribute to devel- oping bone fractures. tress fractures occur as a result of repetitive loading and unloading of a bone [1]. In- Bisphosphonates are preferred drugs in postmenopaus- creased strain or frequency of compression al and corticosteroid-induced osteoporosis [6].
    [Show full text]
  • Metatarsal Fracti]Res
    METATARSAL FRACTI]RES Bradley D. Castellano, DPM Stepben V. Corey, DPM TbomasJ. Merrill, DPM John A. Rucb, DPM As with many common disorders of the foot, the displaced fractures, stress fractures, joint disloca- area of metatarsal fractures has received only tions, intra-articular fractures, severely comminut- superficial attention in historical and current med- ed and even compound fractures. The sllrgeon ical and surgical discr-rssions. General principles must have a thorough working knowledge of of fracture management have been sparingly these injuries in the specific region and unique applied to the topic in most ofihopedic and podi- anatomy of the forefoot. The full scope of poten- atric texts. The fifth metatarsal, however, has tial injury must be appreciated to avoid misdiag- received some degree of attention uncler the nosis and inappropriate treatment. eponym of the Jones' fracture. The eponym how- The variety of injuries to the metatarsal ever is often misapplied to the common avulsion region can be systematically classified. This type fracture of the fifth metatarsal base. Most refer- of classification can serve the same purpose as ences ciealing with the subject are interesting per- the Lauge-Hansen system in ankle fractures. A sonal experiences with metatarsal fractures and working knowledge of the mechanism of injury is an attempt to introduce a new or re-visited tech- also the key to successful management of many nique for the management of a unique or bizarre of the common injuries through conservative injury. Figura presents a iogical and rather com- methods or closed reduction techniques. plete classification of metatarsal fractures and dis- Complete clinical and radiographic evalua- cusses treatment.l tion are essential stepping stones in the success- State of the art has yet to be described in the ful management of metatarsal fractures.
    [Show full text]
  • Osteoid Osteoma of the Fifth Metatarsal Bone
    Bahrain Medical Bulletin, Vol. 31, No. 3, September 2009 Osteoid Osteoma of the Fifth Metatarsal Bone Mohammed Albagali, MBBS, CABS Ortho* Haider Mohammed, MRCSI, FICMS Ortho** Fareed Salloom, MD, CABS Ortho*** Mohammed Hussain, MD**** A twelve-year-old male with 6-week history of atraumatic pain in the lateral aspect of his right forefoot not responding to conservative treatment were seen in the orthopedic clinic. The pain was worse at night and relieved with non-steroidal anti-inflammatory drugs. Plain radiographs and MRI revealed features of osteoid osteoma of the right fifth metatarsal bone. The osteoid osteoma was removed by curettage, which gave the patient a complete relief of his presenting symptoms. This case demonstrates the rare anatomic position of osteoid osteoma. Bahrain Med Bull 2009; 31(3): Osteoid osteoma is a benign skeletal neoplasm of unknown etiology. It is composed of osteoid and woven bone. This tumor consists of a centrally located vascularized nidus, typically surrounded by a variable amount of sclerotic reaction. The nidus is usually 1-10 mm in diameter1. It is a common bone tumor, comprising approximately 10-12% of benign bone tumors2. Although any bone of the skeleton can be involved, approximately 50% of all osteoid osteomas occur in the femur and tibia2. In the foot, it accounts for approximately 4% of cases3. The commonest site in the foot is the talus4-6. The classic presentation of osteoid osteoma is a focal bone pain, which worsens at night and increases with activity. The level of prostaglandin E2 is markedly elevated in the nidus; this is presumably the cause of pain and vasodilatation, and it is the reason for the pain being relieved dramatically with small doses of aspirin7.
    [Show full text]
  • Earliest Complete Hominin Fifth Metatarsal-Implications for the Evolution of the Lateral Column of the Foot
    AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 000:000–000 (2009) Earliest Complete Hominin Fifth Metatarsal—Implications for the Evolution of the Lateral Column of the Foot Bernhard Zipfel,1,2* Jeremy M. DeSilva,3 and Robert S. Kidd4,5 1Bernard Price Institute for Palaeontological Research, School of Geosciences, University of the Witwatersrand, PO Wits, 2050 Wits, South Africa 2Institute for Human Evolution, University of the Witwatersrand, PO Wits, 2050 Wits, South Africa 3Department of Anthropology, Boston University, Boston, MA 02115 4School of Biomedical and Health Sciences, University of Western Sydney, Cambelltown, NSW 2560, Australia 5Institute for Human Evolution, University of the Witwatersrand, PO Wits, 2050 Wits, South Africa KEY WORDS fossil metatarsal; hominins; bipedalism; Sterkfontein ABSTRACT StW 114/115, from Sterkfontein, South We conclude that, at least in the lateral component of Africa, is the earliest complete hominin fifth metatarsal. the foot of the StW 114/115 individual, the biomechani- Comparisons of StW 114/115 to modern humans, extant cal pattern is very similar to that of modern humans. apes, and partial hominin metatarsals AL 333-13, AL This, however, may not have been the case in the 333-78, SKX 33380, OH 8, and KNM-ER 803f reveal a medial column of the foot, as a mosaic pattern of homi- similar morphology in all six fossils consistent with ha- nin foot evolution and function has been suggested. The bitual bipedality. Although StW 114/115 possesses some results of this study may support the hypothesis of an primitive characters, the proximal articular morphology increased calcaneo-cuboid stability having been an early and internal torsion of the head are very human-like, evolutionary event in the history of terrestrial bipedal- suggesting a stable lateral column and the likely pres- ism.
    [Show full text]
  • Stress Fractures of the Foot and Ankle
    Nebraska Foot & Ankle, P.C. 7030 Helen Witt Drive, Suite B, Lincoln, NE 68512 P: 402.420.0400 F: 402.420.0402 Stress Fractures of the Foot and Ankle Stress fractures are a type of overuse injury. These tiny cracks in your bones develop when your muscles become overtired (fatigued) and can no longer absorb the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones, creating a small crack or fracture. Stress fractures also can occur with normal usage if osteoporosis or some other disease weakens your bones and leaves them vulnerable. These fractures are often called "insufficiency fractures" because there isn’t enough bone to withstand the normal stress of daily use. Most stress fractures occur in the weightbearing bones of the foot and lower leg. The most commonly affected site is the second or third of the long bones (metatarsals) between the toes and the midfoot. Stress fractures also can occur in the heel, the outer bone of the lower leg (fibula) and the navicular, a bone on the top of the midfoot. Who’s at risk? Athletes who participate in high-impact sports such as track and field, basketball, gymnastics, ballet or tennis Adolescents whose bones have not yet fully hardened Women, particularly female athletes, who have abnormal or absent menstrual cycles that can result in decreasing bone mass Military recruits who suddenly must shift from a sedentary civilian life to a more active training regime Causes of stress fractures Doing too much too soon is a common cause of stress fractures.
    [Show full text]
  • UPDATED FX Only Ortho Reference Sheetv2.Xlsx
    FRACTURES Note-not an inclusive list, top frequent listed only NOTE: A fracture not indicated as displaced or nondisplaced should be coded to displaced A fracture not indicated as open or closed should be coded to closed The open fracture designations are based on the Gustilo open fracture classification The appropriate 7th character is to be added to each code below where applicable: A - initial encounter for closed fracture B - initial encounter for open fracture type I or II; initiaal encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with rountine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB,or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela BACK S22.010x Wedge compression fracture of first thoracic vertebra S22.078x
    [Show full text]
  • Multiple Foot Fractures Treated with Multiple Minirail External Fixation: a Case Report
    CHAPTER 39 Multiple Foot Fractures Treated With Multiple Minirail External Fixation: A Case Report Hamed Jafary, DPM Ralph Ramos, DPM Cherison A. Cuffy, DPM Thomas Merrill, DPM INTRODUCTION compressed fracture of the navicular bone, fracture of the second through fifth metatarsal bones, and complete lateral Patients with multiple foot fractures can be challenging dislocation of the fifth metatarsal bone (Figure 1). Jones when performing surgical correction. Fracture reduction compression with a posterior splint was applied to the left can be accomplished by closed or open methods by the lower extremity and the patient was scheduled for surgery means of an external fixator, screws, plating, Kirschner wire the following morning. (K-wire), Steinmann pins, and tension band wiring. The difficulty is in the size of the bone in the foot and attempting SURGICAL APPROACH to realign the small fragments of bone. In order to achieve adequate results, the bone needs to be placed in the correct The surgical approach started with percutaneous fixation alignment and held in place with stable fixation (1). The of the medical malleolus. A K-wire was driven from distal- use of external fixation helps with adding stability across the medial to proximal-lateral in order to capture the fracture fracture sites (2). Other challenges such as soft tissue quality fragment. This procedure was done under fluoroscopy. after a traumatic injury can benefit from minimal incisions Then via the cannulated system, a drill was used to overdrill and the use of percutaneous wiring or external fixation to the wire, and the fracture fragment was secured with 2 minimize further damage of the soft tissue (3).
    [Show full text]
  • Common Orthopaedic Foot & Ankle Diagnoses Encountered in the Primary Care Setting
    12 Osteopathic Family Physician (2016) 12 - 19 Osteopathic Family Physician | Volume 8, No. 4 | July/August, 2016 REVIew article Common Orthopaedic Foot & Ankle Diagnoses Encountered in the Primary Care Setting Matthew Martell, DO,1 Adam Bitterman, DO,2 Brett Auerbach, DO,3 & Simon Lee, MD4 1 Northwell Health System - Plainview Hospital, Plainview, NY 2 Rush University Medical Center, Chicago, IL 3 Orthopaedic Research of Virginia, Richmond, VA 4 Rush University Medical Center, Chicago, IL Keywords: Foot and ankle disorders are commonly encountered in the primary care setting. Many of these disorders can be successfully managed by primary care physicians, allowing for early detection and Foot, Ankle prompt treatment. However, there are circumstances when patients require a referral to a foot Achilles Tendon and ankle specialist to decrease potential complications of these disorders. This article will review ten common foot and ankle disorders to aid in the improved understanding of when conservative Ankle Sprains management is appropriate and when referral to a specialist is necessary. Ankle Fractures Plantar Fasciits Sports Medicine Orthopedics Peroneal Tendon Injuries INTRODUCTION Foot and ankle disorders are commonly encountered in the pri- Ankle sprains can be diffcult to differentiate from other condi- mary care setting. Many of these disorders can be successfully tions, including fractures, tendon ruptures and midfoot injuries. managed by primary care physicians, allowing for early detection Patients may present with bony tenderness to palpation (TTP) if and prompt treatment. However, there are circumstances when there is an avulsion rather than a mid-substance ligament tear. patients require a referral to a foot and ankle specialist to de- Ankle stability can be assessed by performing the anterior and crease potential complications of these disorders.1 This article will posterior drawer tests, the talar tilt test, Kleiger’s test and the dor- review ten common foot and ankle disorders to aid in the determi- sifexion torque test.
    [Show full text]
  • Intramedullary Screw Fixation of Proximal Fifth Metatarsal Fractures in Athletes
    02 - aob 426 ARTIGO ORIGINAL OSTEOSSÍNTESE COM PARAFUSO INTRAMEDULAR NAS FRATURAS PROXIMAIS DO QUINTO METATARSIANO DO ATLETA INTRAMEDULLARY SCREW FIXATION OF PROXIMAL FIFTH METATARSAL FRACTURES IN ATHLETES MARTA MARIA TEIXEIRA DE OLIVEIRA MASSADA1, MANUEL ALEXANDRE NEGRAIS PINHO GONÇALVES PEREIRA1, RICARDO JORGE GOMES DE SOUSA1, PAULO GUIMARÃES COSTA1, JOSÉ LEANDRO DA ROCHA MASSADA2 RESUMO Abstract Objetivo: Avaliar os resultados clínicos e radiológicos da osteossíntese Objective: The purpose of this study was to review the short- com parafuso de compressão intramedular nas fraturas proximais do and long-term clinical and radiological results of intramedullary quinto metatarsiano no atleta. Métodos: Foram incluídos no estudo 11 compression screw fixation of proximal fifth metatarsal fractures homens e seis mulheres com diagnóstico de fratura das zonas II e III do in athletes. Methods: Eleven male and six female active patients quinto metatarsiano. Quinze dos pacientes praticavam esporte a nível with fifth metatarsal zone II and zone III fractures fixed with a 4.5- profissional ou de alto rendimento (futebol: n=11; basquetebol: n=1; mm cannulated compression screw were evaluated by chart atletismo: n=3) e dois praticavam atividade esportiva regular a nível re- review, review of radiographs, and clinical evaluation. Fifteen creacional. Foram submetidos a fixação cirúrgica com parafuso canulado of the patients were high-level athletes (soccer: n=11; baske- de compressão (4.5mm de diâmetro). Todos os pacientes foram avaliados tball: n=1; track and field: n=3) and two were recreational-level clinicamente e através da revisão do processo clínico e dos estudos ima- athletes. Mean follow-up from surgery to evaluation was 54 giológicos.
    [Show full text]
  • Stress Fractures of the Fifth Metatarsal
    http://dx.doi.org/10.14517/aosm15025 Review Article pISSN 2289-005X·eISSN 2289-0068 Stress fractures of the fifth metatarsal Jae-Young Lee, Jin-Wha Chung Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary’s Hospital, Bucheon, Korea A stress fracture can be defined as a spontaneous fracture due to accumulation of stress on a healthy bone. Stress frac- tures of the 5th metatarsal usually locate to the proximal 1.5 cm of the metatarsal shaft, a characteristic based on ana- tomical and biomechanical parameters. Many surgeons agree that the postoperative outcome of 5th metatarsal stress fractures tend to be associated with prolonged healing time, with nonunion, and sometimes with refracture. Acute stress fractures have been treated with immobilization using a non-weight-bearing cast, but the incidence of complications (delayed union or nonunion) after non-surgical treatment makes surgical treatment a more favorable treatment option for competitive athletes, even for young adults. Curettage and bone grafting or intramedullary screw fixation, the stan- dard surgical treatment for the 5th metatarsal stress fractures, has been associated with rapid recovery and early return to physical activities. Malalignment or instability of the foot or ankle must be addressed at the time of surgical treatment. Keywords: Fifth metatarsal; Stress fracture; Metatarsal fracture; Jones fracture INTRODUCTION 5th metatarsal fractures make it a condition of clinical significance and one that requires an accurate diagnosis In stress fractures, a sustained submaximal external force, and an appropriate treatment [3]. In 1902, Jones sug- which is just inadequate to induce an acute fracture, over- gested that a base fracture of the 5th metatarsal may also lays the bone and causes a characteristic hairline fracture occur as a result of an indirect trauma [4].
    [Show full text]