CHAPTER 66 • LOWER EXTREMITY STRESS FRACTURE 395- The stress fracture at the base of the second metatarsal
is known as the dancer’s fracture. Pain is noted to be
greatest when in the full en pointeposition. During
this maneuver the foot is maximally plantarflexed and
weight is borne on the plantar aspect and tip of the
first and second distal phalanges (Micheli, Sohn, and
Soloman, 1985). - The dance’s fracture should be recognized early and
treated with at least 4 weeks of nonweightbearing
immobilization (Micheli, Sohn, and Soloman,
1985). - Stress fractures of the proximal fifth metatarsal diaph-
ysis that occur approximately 1.5 cm distal to the
tuberosity are known as the Jones fracture. It is
important to differentiate this fracture from the acute
avulsion fracture of the tuberosity of the 5th
metatarsal. The avulsion injury is noncritical and is
treated with relative rest then gradual progression.
The Jones fracture is notorious for poor healing and
requires prolonged weightbearing (6–12 weeks) and
often requires screw fixation (Oloff and Schulhofer,
1996).
SESMOIDS
- Sesmoid stress fracture can be particularly disabling
and can result in delayed union or nonunion. Passive
distal push of the sesmoid, direct tenderness, and ses-
moid area pain with stretch of the flexor hallucis sug-
gest the diagnosis. - Radiographic changes may be difficult to detect ses-
moid stress fracture, but occasionally axial views or
magnification views can assist in diagnosis. Separation
of the sesmoid fragments and irregular edges suggest a
stress fracture rather than a bipartite sesmoid. Since a
bone scan is nonspecific, CT scan or MRI is often indi-
cated to confirm the diagnosis (Bergman and
Fredericson, 1999). - Rest from the offending activity is clearly advised.
Treatment involves casting in a nonweightbearing
short leg cast with specific prevention of dorsiflexion
for 6 weeks (Oloff and Schulhofer, 1996).
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