In the first part of a two-part article, Chris Mallac presents a case study of an elite footballer who suffered a proximal 2ndmetatarsal fracture and a 3rdmetatarsal stress reaction. In this issue, Chris discusses the causative factors in the pathogenesis of metatarsal stress fractures and how they are diagnosed.
Stress fractures of the metatarsals are a common overuse injury in athletes and dancers, and are only second to tibial stress fractures in terms of incidence(1). Stress fractures of the metatarsals are also common in military recruits and in long-distance runners and team sport athletes who cover large mileages in training and competition.
It has been reported that 10%(2)to 20%(3)of stress fractures in athletes, and 23%(4)of stress fractures in military recruits are located in the metatarsals. In terms of location, it is more common for the 2ndand 3rdmetatarsals to suffer stress reactions and fractures in the shaft and the non-proximal end of the bone. Indeed, the second and third metatarsal account for 80–90% of all metatarsal fractures(1,5,6). By contrast, proximal fractures in the heads of the metatarsals are not common.
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