March Fractures

Source: Wheeless' Textbook of Orthopedics

Synopsis

A stress fracture of the metatarsals is known as a March fracture, because it was first described as a condition amongst army recruits, marching with heavy loads. The condition usually arises as a result of unaccustomed loading of the bone, eg a sudden increase in exercise intensity. It is particularly common in adolescents, and middle-aged runners.

The 2nd or 3rd metatarsals are the most susceptible to this injury, which results in pain in the forefoot, aggravated by impact. The onset is sudden (unlike metatarsalgia, which usually builds up gradually), and the foot will be swollen over the fracture site. It is very often more painful on the dorsum (top) of the foot.

Treatment

Treatment is often conservative in approach: rest from weight-bearing for 4-6 weeks. Mild cases may require an orthotic device placed into the shoe for support. Moderate cases require plaster-cast or the equivalent. Advice on the return to training is essential, since it is often poor training regimes which are the origin of this problem.