Radiographic Evaluation of Foot Structure following Fifth Metatarsal Stress Fracture

Lee, Kyung Tai; Kim, Ki Chun; Park, Young Uk; Kim, Tae Won; Lee, Young Koo

doi:10.3113/fai.2011.0796

Cited by 58 publications

(41 citation statements)

References 14 publications

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“…Several theories about risk factors like cavovarus foot22 23 and curved type fifth metatarsal bone in the medial oblique radiograph23 have been reported. Different prognostic factors like Torg classification,24 zones according to Lawrence25 and the plantar gap26 might predict outcome and guide treatment.…”

Section: Introductionmentioning

confidence: 99%

Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

et al. 2014

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AimTo compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal.MethodsSystematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective studies. Two reviewers independently extracted data and assessed methodological quality. Main outcomes were return to sport and complication rate.Results18 studies were included (2 anterior tibia (N=31), 8 navicular (N=200) and 8 fifth metatarsal (N=246)). For anterior tibial fracture, no studies on initial surgery were eligible. Conservative treatment resulted in high complication rates and few cases returned to sport. For navicular fracture, a weighted mean return to sport of 22 for conservative and 16 weeks for surgical treatment was found. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Surgical procedures varied widely. For the fifth metatarsal fracture, weighted mean return to sport was 19 for conservative and 14 weeks for surgical treatment. Surgery consisted of intramedullary screw fixation or tension band wiring. For conservative methods, insufficient details were reported. Overall, there was a high risk of bias; sample sizes were small and GRADE level of evidence was low.ConclusionsStrong conclusions for surgical or conservative therapy for these high-risk stress fractures cannot be drawn; quality of evidence is low and subjected to a high risk of bias. However, there are unsatisfying outcomes of conservative therapy in the anterior tibia. The role of initial surgery is unknown. For the navicular, surgery provided an earlier return to sport; and when treated conservatively, weightbearing should be avoided. For the fifth metatarsal, surgery provided the best results. Treatment decision-making would greatly benefit from further prospective research.Study registration numberPROSPERO database of systematic reviews: CRD42013004201.

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Section: Introductionmentioning

confidence: 99%

Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

et al. 2014

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“…Of these studies, Paiva de Castro et al 72 rately, Burns et al 12 incorporated both case-control (retrospective) and prospective study designs, and McManus et al 56 reported the results of their 2-year prospective study separately for each year. Eleven studies either utilized more than 1 method to categorize foot type 12,46,53 or assessed the foot using continuous scales, 5,7,12,26,38,52,63,79,81 and 4 studies reported on more than 1 lower extremity injury using either a dichotomous outcome 24,38,41 or a continuous scale. 34 In the meta-analysis, to account for all genders, feet (right/left), study designs, low back and lower extremity injuries, and methods of foot-type classification/ assessment reported in the included studies, the outcome of each analysis was entered separately as a unique study.…”

Section: Meta-analysismentioning

confidence: 99%

“…Studies included in qualitative synthesis, n = 34 79 South Africa, 10 Turkey, 34 Taiwan, 41 Korea, 52 and China. 97 There were 12 prospective cohort studies, …”

Section: Study Populationsmentioning

confidence: 99%

Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis

Tong

Kong²

2013

Journal of Orthopaedic & Sports Physical Therapy

145

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T he human foot is often classified into 3 structural categories: high, normal, and low arch, based on its anatomical alignment 89 and the height of the medial longitudinal arch. 27 Classification in these 3 categories is typically based on cutoff values determined from the distribution of data (standard deviations 65,93,102 or percentiles 15,16 ) from measurements taken on a large population. The interest in such classification is the belief that nonneutral foot morphology, such as a high or low arch (flatfoot), may lead to less than optimal foot function and be associated with the development of lower extremity and low back injuries. 23,28,29,59 A review of the literature provides conflicting evidence on the potential relationship between foot type and lower extremity injuries. Although a number of published reports have found no relationships between nonneutral foot types and lower extremity injuries, 40,94,96,99 the authors of a recent systematic review concluded that both high-and low-arch foot types were associated with runningrelated injuries. 14 The results of this systematic review, 14 which did not include a meta-analysis and effect-size estimates, contrast those of a few qualitative reviews that failed to demonstrate a relationship between foot type and future lower extremity injuries. 4,8,20,70 This lack of consensus in the literature could be attributed, in part, to the variation in the operational definition of foot type among investigators. 4,70 A large variety of methods have been developed to classify the foot based on structure and alignment. These T T OBJECTIVES:To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. T T METHODS:A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, casecontrol, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A randomeffects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. T T RESULTS:Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/ physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries.

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“…Progression to non-union of these fractures is contributed to by the presence of a perfusion watershed at the metaphysis/diaphysis junction between the proximally tracking nutrient artery, which enters the bone at the proximal diaphysis, and the metaphyseal artery [8]. Other predisposing factors include cavovarus foot alignment, as well as an increasing inter-metatarsal angle between the 4th and 5th metatarsals and a protruding 5th metatarsal head [9][10][11].…”

Section: Metatarsalmentioning

confidence: 98%

Stress fractures of the foot and ankle

Welck,

Hayes,

Pastides

et al. 2017

Injury

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Radiographic Evaluation of Foot Structure following Fifth Metatarsal Stress Fracture

Cited by 58 publications

References 14 publications

Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis

Stress fractures of the foot and ankle

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