Foot stress fractures
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Foot Stress Fractures. Rachel Callis February 2, 2006 Radiology. Anatomy. Divisions Forefoot toes, metatarsals Midfoot 3 cuneiforms, cuboid, navicular Rearfoot talus, calcaneus Ankle tibia, fibula. Anatomy. Stress Fractures. Originally described in 1855

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Foot Stress Fractures

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Foot Stress Fractures

Rachel Callis

February 2, 2006

Radiology


Anatomy

  • Divisions

    • Forefoot

      • toes, metatarsals

    • Midfoot

      • 3 cuneiforms, cuboid, navicular

    • Rearfoot

      • talus, calcaneus

    • Ankle

      • tibia, fibula


Anatomy


Stress Fractures

  • Originally described in 1855

  • Due to repetitive stress, bone fatigue

  • Most common in LE

    • “march fracture,” “en pointe”

  • 10% of pts in sports medicine practice

  • 17% bilateral


Stress Fractures

  • 34%Tibia

  • 24%Fibula

  • 18%Metatarsals

    - 2nd and 3rd metatarsals

  • Navicular most common of tarsal bones

  • Calcaneous, the rest


Radiology


Foot Radiograph ABC’s

  • A

    • Alignment

      • TMTJs = tarsometatarsal joints

  • B

    • Bones

      • Trace the cortex = AP medial 2, MO lateral 3

      • Accessory bones

  • C

    • Congruity

      • Forefoot joints on AP and MO


Radiology


Accessory Bones


Fracture Classification

  • Salter-Harris


Fracture Classification


Stress Fractures

  • Injuries

    • Acute< 2 wks

    • Subacute2-6 wks

    • Chronic6+ wks

  • Fractures usually linear

  • Located in central 1/3


Stress Fractures

  • Diagnosis

    • Discrete localized swelling and dull pain

    • Worsens with exercise or weight bearing

  • Tenderness to palpation at injury site

  • Continuum

  • X-rays

    • may not appear for 2-10 wks

    • Sensitivity as low as 15%

  • 50% of repeated x-rays will show fractures


Radiographs

Initial

2 wks

1 mo

3 mo


Stress Fractures

  • Triple phase nuclear bone

    scans more sensitive

  • MRI/CT


Figure 5. Athlete with complete navicular stress fracture. A, Radiograph with complete navicular stress fracture (arrow). B, CT scan of same athlete more clearly demonstrating navicular stress fracture (arrow).

Navicular Stress Fracture


Navicular Stress Fractures


Calcaneus StressFracture


Treatment

  • RICE

    • Rest

    • Ice(limit to 20 min/hr)

    • Compression

    • Elevation

  • NSAIDs

  • Short leg casts for metatarsal and navicular fractures


Prevention

  • Gradual increase in exercise intensity

  • Stretching

  • Supportive shoes


Works Cited

  • Clanton, TO, DA Porter. Primary care of the injured athlete, Part 1: Primary care of foot and ankle injuries in the athlete. Clin Sports Med. 1997. 16(3):435-66.

  • Damon, JS, AH Newberg. Imaging of stress fractures in the athlete. Radiol Clin N Am. 2002; 40:313-331.

  • Gellman, R, S Burns. Walking aches and Running Pains. Orthopedics. 1996. 23(2):263-280.

  • Hatch, RL, S Hacking. Evaluation and management of toe fractures. Am Fam Physician. 2003. 68(12):2413-2418.

  • Judd, DB, DH Kim. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician. 2002. 66(5):785-794.

  • Mittlmeier, T, P Haar. Sesamoid and toe fractures. Injury, Int J Care Injured. 2004. 35:S-B87-S-B97.

  • Pearse, EO, B Klass, SP Bendall. The ‘ABC’ of examining foot radiographs. Ann R Coll Surg Engl. 2005. 87:449-451.

  • Ribbans, WJ, R Natarajan, S Alavala. Pediatric Foot Fractures. Clin Orthop. 2005. 432:107-115.

  • Sanderlin, BW, RF Raspa. Common stress fractures. Am Fam Physician. 2003; 68(8):1527-1532.


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