March fracture, is the fracture of the distal third of one of the

metatarsals The metatarsal bones, or metatarsus, are a group of five long bones in the foot, located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes. Lacking individual names, the metatarsal bones are numbered from the me ...

occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and people whose duties entail much standing (such as hospital doctors). March fractures most commonly occur in the second and third metatarsal bones of the foot.Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery It is a common cause of foot pain, especially when people suddenly increase their activities.

Signs and symptoms

The onset is not dramatic. When the boot or

shoes A shoe is an item of footwear intended to protect and comfort the human foot. They are often worn with a sock. Shoes are also used as an item of decoration and fashion. The design of shoes has varied enormously through time and from culture t ...

are taken off, there is a cramp-like pain in the affected forefoot, and moderate local edema appears on the dorsal aspect. On moving each toe in turn, that of the involved metatarsal causes pain, and when the bone is palpated from the

dorsal Dorsal (from Latin ''dorsum'' ‘back’) may refer to: * Dorsal (anatomy), an anatomical term of location referring to the back or upper side of an organism or parts of an organism * Dorsal, positioned on top of an aircraft's fuselage * Dorsal c ...

surface, a point of tenderness is found directly over the lesion.

Radiography Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeu ...

at this stage is negative, but the condition is diagnosed correctly by military surgeons without the aid of

x-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s. In civil life, it is seldom diagnosed correctly for a week or two, when, because of lack of immobilization, there is an excessive deposit of

callus A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may o ...

(which may be palpable) around the fracture.

Diagnosis

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

is seldom helpful, but a CT scan and an

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

study may help in diagnosis. Bone scans are positive early on.

Dual energy X-ray absorptiometry Dual-energy X-ray absorptiometry (DXA, or DEXA) is a means of measuring bone mineral density (BMD) using Spectral imaging (radiography), spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft ...

is also helpful to rule out comorbid osteoporosis.

Differential diagnosis

* Acute metatarsal fracture *

Hallux rigidus Hallux rigidus or stiff big toe is Osteoarthritis, degenerative arthritis and stiffness due to Osteophyte, bone spurs that affects the metatarsophalangeal joints (MTP) at the base of the hallux (big toe). Hallux flexus was initially described by ...

Jones fracture A Jones fracture is a broken bone in a specific part of the fifth metatarsal of the foot between the base and middle part that is known for its high rate of delayed healing or nonunion. It results in pain near the midportion of the foot on the ...

* Sesamoid stress fracture * Acute sesamoid fracture * Proximal fifth metatarsal avulsion fracture

Treatment

The first line treatment should be reduction of movements for 6 to 12 weeks. Wooden-soled shoes or a cast should be given for this purpose. In rare cases in which stress fracture occurs with a cavus foot,

plantar fascia The plantar fascia is the thick connective tissue ( aponeurosis) which supports the arch on the bottom (plantar side) of the foot. It runs from the tuberosity of the calcaneus (heel bone) forward to the heads of the metatarsal bones (the bon ...

release may be appropriate.

Occurrence

Stress fractures A stress fracture is a fatigue-induced bone fracture caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated injury from repeated submaximal loading, such as running or ...

can occur at many sites in the body; "march fracture" simply refers to a stress fracture specifically of the metatarsals, so named because the injury is sometimes sustained by soldiers during sustained periods of marching. Although march fractures can occur to the 5th metatarsal, fractures of this bone are more likely to be trauma-related fractures to the

diaphysis The diaphysis is the main or midsection (shaft) of a long bone. It is made up of cortical bone and usually contains bone marrow and adipose tissue (fat). It is a middle tubular part composed of compact bone which surrounds a central marrow cavit ...

, termed

s. In runners, march fracture occurs most often in the metatarsal neck, while in dancers it occurs in the proximal shaft. In ballet dancers, fracture mostly occurs at the base of the

second metatarsal The second metatarsal bone is a long bone in the foot. It is the longest of the metatarsal bones, being prolonged backward and held firmly into the recess formed by the three cuneiform bones. The second metatarsal forms joints with the second pr ...

and at Lisfranc joints. This fracture always occurs following a prolonged stress or weight bearing, and the history of direct trauma is very rare. Consideration should always be given to osteoporosis and

osteomalacia Osteomalacia is a disease characterized by the softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The impairment of bon ...

. Cavus feet are a risk factor for march fracture. Best Shoes for Lisfranc Injury
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References

External links

{{DEFAULTSORT:March fracture Bone fractures Injuries of ankle and foot