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Stress Fractures of the Midfoot and Forefoot

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Stress Fractures in Athletes

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Abstract

Stress fractures of the midfoot and forefoot are encountered frequently in athletes. In the general athlete population, stress fractures only have an incidence of approximately 1%; however, among athletes participating in running and jumping sports, the incidence increases to 15–20% (Fredericson et al., Top Magn Reson Imaging 17(5):309–25, 2006; Khan et al., Sports Health 10(2):169–74, 2018). In evaluating patients with potential stress injuries, clinicians should maintain a high index of suspicion as delays in diagnosis are common and often lead to prolonged pain, disability, and loss of time in sport. Patients usually present with a history of insidious, progressive activity-related pain without an inciting or traumatic event. Plain radiographs are often negative, and advanced imaging including MRI, CT, or bone scans is often needed to confirm the diagnosis of stress fracture.

Stress fractures of the foot include those involving the metatarsals, navicular, cuboid, cuneiform, and sesamoid. Metatarsal stress fractures (MTSF) are the most common stress fractures about the mid- and forefoot. First through fourth metatarsal stress fractures can often be managed successfully with protected weight-bearing. Surgical management of the fifth metatarsal stress fractures is often recommended especially for the elite-level athlete as it leads to earlier union with reduced rates of refracture. Navicular stress fractures are considered high risk given their elevated propensity to delayed healing, nonunion, fracture progression, and refracture. If identified early, navicular stress fractures can be managed successfully using conservative modalities. Operative management is warranted after failure of conservative management and in select elite athletes for more reliable return to play. Cuboid and cuneiform stress fractures are exceptionally rare and difficult to diagnose but commonly heal after a period of immobilization. Sesamoid stress fractures are uncommon and challenging injuries to treat. Management begins conservatively with immobilization. Surgery is indicated after 6 or more months of failed conservative management. This chapter will cover in detail stress fractures of the midfoot and forefoot as well as their diagnosis and recommended management strategies.

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Authors and Affiliations

  1. Washington University, Department of Orthopedic Surgery, St. Louis, MO, USA

    Justin J. Hicks, Parth Vyas, Jonathon Backus & Ljiljana Bogunovic

Authors
  1. Justin J. Hicks
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  2. Parth Vyas
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  3. Jonathon Backus
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  4. Ljiljana Bogunovic
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Correspondence to Ljiljana Bogunovic .

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Editors and Affiliations

  1. Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical, Columbus, OH, USA

    Timothy L. Miller

  2. Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical, Columbus, OH, USA

    Christopher C. Kaeding

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Hicks, J.J., Vyas, P., Backus, J., Bogunovic, L. (2020). Stress Fractures of the Midfoot and Forefoot. In: Miller, T.L., Kaeding, C.C. (eds) Stress Fractures in Athletes. Springer, Cham. https://doi.org/10.1007/978-3-030-46919-1_19

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  • DOI: https://doi.org/10.1007/978-3-030-46919-1_19

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