March Fracture

March fracture (toe) is defined as a fatigue fracture occurring in the metatarsal bone of the foot. It is usually observed in the second metatarsal and is one of the common causes of foot pain.

Also known as a metatarsal stress fracture, it is a complete or incomplete hairline break in the foot bone. Metatarsals are the five sets of bones that fan out towards the toes.

Description

The condition is a type of stress fracture that occurs due to the strain caused by repetitive exercise and is very commonly seen in army personnel, nurses and athletes.

It derives its name from the young military recruits who developed stress fractures after long marches during the World War I.

The problem can cause pain with activity and may also lead to swelling and pain, even when at rest.

Incidence and Prevalence

Apart from military recruits, march fractures are seen in runners and patients with rheumatoid arthritis (RA), metabolic bone disease and neuropathic conditions.

Overall, stress fractures are known to comprise up to 16% of all injuries related to athletic participation in the US. While 95% of stress fractures involve the lower extremities, the metatarsals are the most common structures involved.

Key Symptoms

To begin with, a patient suffering from a march fracture (toe) complains of foot pain. The patient will normally complain of a tender lump on the back of the foot.

Those suffering from march fracture can feel pain in the middle of the long bone of the foot, which slowly increases with distance, reaching a peak as you near the end of the run. In addition, the pain is likely to return earlier in the next session, forcing an earlier finish. Apart from the pain, the patient will also be able to feel a little swelling around an established stress fracture.

A stress fracture normally develops over a period of several days, weeks or even months.

Causes of March Fracture (Toe)

These Fractures normally occur when people suddenly increase the pace and intensity of their activities.

A combination of muscle fatigue and bone failure is considered to be the cause of march fracture. The condition occurs in situations where bone remodeling predominates over repair.

There is a disruption in the continuity of normal bone caused by repetitive microtrauma to an area.

Here we list some of the other causes of march fracture (toe):

• Age (adults over age 60 are more vulnerable)
• Walking, running, jogging or standing for prolonged periods
• History of bone or joint disease, especially osteoporosis
• Obesity
• Malnourishment, especially calcium deficiency
• New footwear
• Neuropathic foot

Diagnosis

For the purpose of the diagnosis of a metatarsal stress fracture, the doctor will first conduct a series of x-rays, which show an evidence of a stress fracture trying to heal. However, when pain is the only symptom, a bone scan is the only method to confirm the diagnosis of a stress fracture.

Radiology is also a normal procedure carried out in the early stages of this condition. However, later radiographs show a hairline fracture and in more severe cases, the development of callus is often observed.

In addition, if the situation requires, an MRI is also obtained.

Treatment Options

The two most important lines of treatment advised for relief from symptoms of march fracture (toe) include rest and wearing a cast. You need to totally abstain from running if that caused the initial discomfort.

If the patient feels comfortable doing it, he may be able to swim or cycle as long as it does not trigger pain. Experts also recommend an adequate calcium intake. i.e. 1000 mg to 1500 mg every day, along with milk and milk products or calcium supplements.

In addition, narcotic or synthetic narcotic pain relievers often provide help for severe pain. Some patients are also advised to take acetaminophen or ibuprofen for mild pain after the initial treatment.

Once the cast is removed (if in use), frequent ice massage should be done. Gentle massage should be done to provide comfort and decrease swelling.

Pain normally resolves after 5 to 6 weeks after the fracture union occurs.

Research indicates that only a mere 5 percent of stress fractures fail to heal as expected and some form of malunion occurs.

In cases where such stress fractures are not allowed to heal properly, it might become a complete fracture and can even lead to surgical intervention.