Second Metatarsal Stress Fracture in Sports: Comparative Risk Factors between Proximal and Non-proximal Locations

Bavornrit Chuckpaiwong ¹, Chad Cook ¹, Ricado Pietrobon ¹ and James A Nunley ^1*

¹ Duke University Medical Center, United States

^* To whom correspondence should be addressed. E-mail: nunle001{at}mc.duke.edu.

Accepted 21 February 2007

Abstract

Background: Stress fractures of the second metatarsal are common in individuals who participate in athletics or in military recruits, but difficult to diagnosis. Prognosis and treatment of second metatarsal stress fractures between the proximal (base) and non-proximal locations are different; therefore differentiation of fracture location is warranted. At present, differences in risk factors and/or clinical findings between proximal and non-proximal stress fractures remained unstudied. We hypothesized that different risk factors and/or clinical findings associated with proximal and non-proximal stress fractures of the second metatarsal exist.

Methods: Patients diagnosed with proximal stress fractures of the second metatarsal were included in the study. Retrospectively, an age-matched control group with a non-proximal stress fracture was selected for comparison. Statistical analyses involved bivariate comparisons of demographic variables and clinical measurement between the two groups.

Results: Individuals with proximal stress fractures were more likely to be chronically affected, usually exhibited an Achilles contracture, demonstrated size differences in length of first to second metatarsal, were more likely to experience multiple stress fractures, and especially exhibited low bone mass. In addition, high training slightly increases risk of a non-proximal fracture while low training was associated with a proximal stress fracture.

Conclusions: The preliminary findings suggest that different signs, symptoms, and clinical examination findings are associated with proximal metatarsal stress fractures in comparison to non-proximal stress fractures.

Key Words: Proximal stress fracture, athlete, risk factors, second metatarsal, sports injury

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