Diseases

Marching foot. Marching fracture of the metatarsal bone What is a step fracture of the limb

A lot of people are subject to a marching fracture, including runners, athletes, army recruits, fitness and aerobics enthusiasts of various types, dedicated lovers of heels that increase pressure on the forefoot, overly active tourists and shoppers.

What is a march fracture

A marching fracture is a metatarsal bone injury that occurs as a result of excessive and prolonged physical exertion on the foot. A marching foot can also occur in people who wear “wrong” shoes, redistributing the load on the forefoot and thereby overloading it. Metatarsal fractures are accompanied by pain and swelling of the soft tissues of the foot. There is no specific method of treating this type of fracture, at the site of injury, and the broken parts of the bones grow together on their own. The main thing for the victim is to ensure complete rest for his lower limbs and not to load them unnecessarily.

Causes of the march foot

Causes of a marching fracture of the foot

The first in the list of the most prone to a march fracture of the metatarsal bone are conscripts. Harsh military conditions, unaccustomed shoes, sudden excessive physical exertion and exhausting forced marches - all this creates unbearable conditions for vulnerable and thin bones, they break from excessive and prolonged pressure. The second metatarsal bone suffers the most, the third and fourth are slightly less stressed. In very rare cases, a fracture of the first and fifth metatarsal bones of the foot occurs. This fracture was even named after the soldiers who selflessly march in military service and break the bones of the feet in the process.

Tourists at risk of march fracture

The risk group for marching foot fractures includes tourists who experience during leisure and travel, while sightseeing, hiking, shopping, and so on. The legs of women who prefer heels are especially affected, even in resting conditions. Their metatarsal bones break, unable to withstand the strongest overstress.

Often, a marching foot also occurs in avid athletes, both men and women, with extensive experience and sports experience. The reason for this may be intensive preparation for the competition, changing the style of sports shoes, performing complex exercises after a long break, or without prior preparation.

This unpleasant disease also accompanies representatives of certain professions, characterized by prolonged stay on their feet, walking, carrying weights, and so on. This category includes hairdressers and porters, medical staff, salespeople, waiters, bartenders, tour guides, and so on.

In all cases, the provoking and predetermining factor is the presence of flat feet, physical unpreparedness, as well as wearing uncomfortable and tight shoes. A marching foot can occur in an acute or chronic form, one or several metatarsal bones can break, on one or both legs. However, the course of the disease almost always ends in complete recovery without complications.

Symptoms and diagnosis of a march fracture

Signs of a marching fracture of the foot

The main symptoms of a march fracture are pain and slight swelling over the broken bone. However, the characteristic line of metatarsal bones fracture will not be visible on the x-ray, as they break like a “green branch” - only internal structures are broken, and thin bone tissue remains at the top, connecting the edges of the broken bones. As a result, it should take from 4 to 6 weeks for an x-ray to clearly fix such a fracture. It is worth noting that the marching foot is always.

The most popular method for diagnosing a march fracture is palpation. If pressure on the base of the metatarsal bones brings a sharp pain, and swelling of the soft tissues is clearly visible at the site of the alleged fracture, then the diagnosis is obvious - this is a marching foot. A fresh fracture can also be detected using magnetic resonance imaging. Through special radiography modes, the specialist notices rarefaction of bone tissue, which means that there is a gap in the metatarsal bones of the foot.

Foot massage for a marching fracture

A fracture of the metatarsal bones of the foot does not require reduction, unlike many other bones in the human body. Therefore, for the treatment of a march fracture, it is not necessary to wear an immobilizing cast, and the recovery period will take much less time. Although the pressure on the forefoot should be limited, immediately after recovery, it is necessary to exclude for some time the type of activity that provoked the fatigue bone fracture. Orthopedists recommend using special orthopedic insoles, they will unload broken bones and make it easier to transfer the disease.

And with swelling, pain and inflammation, special anesthetic gels, creams and ointments will help to cope, which should be applied to the sore spot several times a day.

We would like to offer to watch a video on how to massage the foot with a marching fracture

The prognosis for marching fractures is favorable and often does not have any consequences for the health of the victim. After a full recovery, a person can completely immerse himself in work, his personal life and hobbies.

Due to excessive load on the lower limbs, some people may develop a pathology referred to as the marching foot. In the medical reference book, this disease is also listed as a marching fracture or Deichlander's disease. And it is also called the disease of recruits who are not used to daily forced marches.

There is a pathological change in the structure of the metatarsal bones.

In addition to professional predisposition (young soldiers at the beginning of the service, people whose occupation is associated with constant standing, long walking or carrying heavy loads), this pathology may be the result of flat feet or prolonged wearing of uncomfortable shoes.

Reasons for the development of pathology

There are several risk groups who, due to their constant activity, may experience this structural change in the feet.

Recruits are recruits.

Young people find themselves in unusual conditions for themselves:

uncomfortable shoes;
excessive physical activity caused by long daily training (running, forced marches, strength exercises).

These conditions adversely affect the condition of the thin, very vulnerable bones of the foot. From prolonged and excessive pressure, a fracture can occur. The 2nd metatarsal bone is most susceptible to change, sometimes the marching foot captures the 3rd and 4th. Fracture of the 1st and 5th metatarsal bones is much less common. Please note that the pathology is even named after this group "marching", that is, because of the exhausting marches.

Professionals and lovers of tourism.

Here, too, long transitions over rough terrain, especially mountainous ones, cannot be avoided. The lower limbs not only have to support the weight of the body, but also to cope with additional loads (a backpack with equipment, climbs and descents).

True, tourists are not only vacationers in the bosom of nature. Fans of exciting tourist trips with sightseeing can also become victims of the development of pathology. This is especially true for women who prefer to wear shoes with heels. In no case should you wear such shoes; for long walks, you should purchase comfortable, loose, soft flat shoes.

There is a high risk of fracture of the thin bones of the foot
in professional athletes

There is a high risk of getting a fracture of the thin bones of the foot at the time of grueling training in preparation for the competition. Pathology can develop in athletes who have not been involved for some time, and then re-entered the ranks. Sometimes the reason may be a change in the model of sports shoes.

permanent employment

At risk professions that require a long stay on their feet:

hairdressers;
sellers;
bartenders, waiters, cooks;
loaders;
guides;
medical workers;
fashion models;
couriers and so on.

The marching foot is provoked by:

flat feet;
unpreparedness of the body for stress;
uncomfortable shoes.

It is considered exclusively as a pathological restructuring of the diaphyseal bone tissue, which develops against the background of changed external factors and under the influence of constant functional overload of the foot. Pathology should not be considered as inflammatory or oncological.

Symptoms

Pain is the first symptom of a disorder. It can be acute or primary chronic, in the first case a pronounced symptom, in the second - less pronounced:

Acute: manifests itself a few days after overexertion (less common);
Primary chronic: increasing, developing gradually.

With a marching fracture, pain appears
feeling in the midfoot

Pain sensations appear in the middle part of the foot, sometimes unbearable, intense. As a result, a person tries to load the injured limb less, the gait changes, lameness appears.

Of the visible symptoms, we note the formation of swelling of the foot in the region of the metatarsal bones of varying intensity: where the fracture is, the swelling is denser.

In the affected area, there is increased sensitivity of the skin. Changes in skin color (redness) are very rare.

The march form of the fracture is not characterized by the symptoms that accompany most bone fractures: fever, changes in blood composition, open form.

Diagnostics

Pain and swelling, as clear signs of a disorder, require a mandatory visit to a medical facility to find out the causes, make a diagnosis, and, of course, prescribe therapy to get rid of the disorder.

Marching is always a closed fracture. However, a traditional x-ray may not be enough, because the characteristic lines of the fracture will not be in the picture.

Violation of the integrity of the bone tissue occurs inside, while the surface of the bone remains apparently intact (fragments remain connected by a thin layer of bone tissue). A clear fixation of a march-type fracture with the help of an X-ray can be distinguished only after a month and a half.

When the radiograph fails, palpation is used. If, when probing the affected area, the patient feels a sharp pain, if there is a characteristic swelling of the middle part of the foot, then the diagnosis is obvious.

To diagnose a metatarsal fracture, an MRI is also prescribed. Especially the study is effective with fresh breaks.

We also note that the pathological change in the structure of the metatarsal bones has several phases:

There are initial signs of restructuring of the structure of the diaphysis and the surrounding periosteum. In cross section or slightly at an angle, a homogeneous enlightenment 1-3 mm wide is visible. Around the diaphysis in the zone of enlightenment, a periosteal callus is formed (locally or captures the entire diaphysis).
Strengthening of periosteal layers, acquisition of a bone structure with pronounced signs of layering. Dense layers on x-rays are viewed worse.
Enlightenment on the radiograph is not visible due to excessive periosteal layering. The diaphysis thickens and deforms, especially in the restructuring zone. Pain sensations are smoothed out.
Gradual resorption of periosteal layers, the structure of the diaphysis is restored. In the picture, the diaphysis looks thickened, but clear and with smooth edges.

Therapeutic impact

It is not difficult to treat a marching fracture. Conservative methods are used:

for the period of treatment, the patient is provided with conditions for maximum rest of the limb;
the imposition of a plaster bandage for a period of at least a month;
physiotherapy;
massage;
orthopedic shoes or orthopedic insoles for shoes;
topical drugs (ointments, gels) of analgesic action and to relieve swelling.

Subject to the rules of treatment, patients manage to fully recover and return to their usual way of life again.

Marching feet are not a fatal disease, but this disorder can bring discomfort to the daily course of life. It is necessary to monitor the quality of shoes, not to overdo it with physical activity, and in case of signs of a pathological condition, do not hesitate to contact a specialist.

As already mentioned, the marching foot is most often diagnosed in people who are in military service, especially those who have relatively recently entered this path.

Recruits have to get used to wearing uncomfortable shoes, most often not corresponding to the actual size of the foot. In addition, the service is associated with a sharp increase in physical activity on the feet. Both of these factors are key reasons.

Whatever physical activity a person is engaged in, in 70% of cases the greatest load falls on the second metatarsal bone, 20% of the load and, accordingly, the risk of injury - on the third and fourth, and the remaining 10% - on the first and fifth.

Oddly enough, often people get an injury with the name "marching fracture" on vacation. Leading a passive, sedentary lifestyle almost all year round, when they go on vacation, they decide to radically change something: start running along the beach in the morning or walk around local attractions.

The foot, in turn, is not prepared for such changes, therefore it suffers from strong overloads and, unable to withstand them, breaks.

Girls who prefer high heels to comfortable shoes are at risk. How often do we see a lady stumbling on an uneven surface, risking falling and hurting herself.

But inept movement in heels is not a guarantee of injury. Prolonged wearing of such shoes entails an overload of the metatarsus, foot deformity and a fracture of the metatarsal bone, even in comfortable ballet flats.

Many will agree that professional sports are not so much about health as, on the contrary, about risks and losses. So, many athletes, especially during the period of intensive preparation for the upcoming competitions, train for six or even more hours a day.

This is a very big load on all organs and systems, so this category of people needs to visit a specialist regularly, once every six months, for a complete examination.

There are a number of professions that are associated with a risk of getting a march-type fracture. These are teachers, porters and builders, doctors, and other specialists who have to stand or walk for a long time.

Summing up, we can distinguish a list of the main factors that cause the described pathology:

flat feet, regardless of degree;
uncomfortable shoes: too narrow, hard or small in size;
uneven distribution of loads that fall on the foot.

Pathology is most often diagnosed in the military, especially among recruits. This is due to the use of uncomfortable shoes, which, in most cases, simply do not match the size of the soldier.

Also, the appearance of the disease contributes to a sharp increase in the load on the feet. All of these factors are key.

In about 70% of cases, the second metatarsal bone suffers, for the reason that it is the main load. In 20%, the third and fourth are damaged. In the remaining 10%, the first and fifth bones are deformed.

The picture will help you understand:

Very often, a march fracture overtakes people on vacation. This is due to the fact that the vast majority of residents lead a passive lifestyle, and during the holidays they decide to change this by starting to travel on foot and walk long distances.

But the foot cannot cope with such overloads, which leads to bone fractures.

Often this pathology is also found in girls who love long heels. In such female representatives, the risk of fracture is high even during the rest period.

Very often, such a fracture can be found in athletes, especially during the period of active preparation for competitions, when a person trains for about 6 hours a day. That is why all beginners and professional athletes need to be examined by a specialist every six months.

Of course, there is a separate group of citizens whose professions are at risk. Basically, this is a job during which people are on their feet all day. This includes teachers, doctors, loaders, builders, etc.

Symptoms

Having received such a fracture, a person experiences the following signs of injury:

sharp pain in the middle of the foot, which is most strongly felt in the process of walking;
feeling of uncertainty when walking;
lameness, which is delayed for several months;
swelling of the feet;
pain in the area of the damaged metatarsus, felt on palpation.

Unlike other injuries, marching fractures are not associated with symptoms such as: reddening of the skin in the area of injury, fever, subcutaneous hemorrhages, changes found in the blood test.

The main symptoms of a marching fracture are painful sensations in the area of pathology and an almost imperceptible swelling of the defective bone.

A distinctive feature of such damage is that the fracture line will not be visible in the X-ray image. This is due to the fact that the deformation of the bones occurs according to the type of "green branch".

The main signs of a marching foot are slight pain and swelling in the affected area. An x-ray taken during the acute period of the disease reflects the characteristic sites of fractures.

Bone damage occurs according to the green line principle - only deep bone tissues are broken, while superficial ones remain unchanged. These signs can be seen in detail in the photo.

Photo. Closed fracture of the fifth metatarsal bone in the picture

Healing begins 1–2 months after injury. A fatigue fracture is always closed.

The disease begins either acutely - immediately after a large overload of the foot, or gradually - pain develops in the forefoot, which interferes with walking. There is a very dense, painful swelling on the back of the foot.

X-ray detectable changes in a marching fracture appear only after a month, sometimes later. In the middle third of the diaphysis of the second, less often the third metatarsal bone, a transverse line of enlightenment is found, shrouded in a spindle-shaped thickening of the ossified periosteum.

Features of diagnostics

A marching fracture can be classified according to the type of pain.

According to this division, doctors call three groups:

acute, manifesting itself soon after a strong overexertion and associated with gradually subsiding, but very acute pain;
chronic, the symptoms of which develop gradually, but eventually develop into unbearable pain;
subacute - an intermediate state.

Despite the fact that Deichlander's disease, like other types of fractures, is associated with pain, the pathology is not dangerous to human life and health.

In addition, with proper treatment, the risk of experiencing the consequences of an injury is negligible. Recovery after the procedures completed does not take much time.

As soon as a person feels pain in the foot, it is necessary to visit a specialist in the near future, who will conduct an appropriate study.

Among the methods that are used for diagnosis, the following are primarily called:

palpation - feeling the patient's body, in particular the place that hurts;
visual inspection;
questioning the patient about complaints;
laboratory research.

After that, the doctor will be able to make a diagnosis and prescribe medications that are effective in one case or another (stimulating the healing of bone tissue, eliminating pain and discomfort) and physiotherapy procedures.

The difficulty of diagnosing a marching fracture is due to the fact that the fracture line is not visible on the x-ray, since the metatarsal bones do not break completely, but only become covered with cracks. Such a phenomenon in medicine is called the "green branch".

The “green branch” type of fracture is one of the most prosperous, since the periosteum itself does not lose its integrity, and the damage is quickly repaired. Most often occurs in children.

An X-ray image shows such a fracture only after five to seven weeks, which is why Deichlander's disease is called a latent pathology.

How, then, to diagnose? We return to the list of basic methods: the doctor feels the potential fracture site and evaluates the pain that the patient describes.

Another diagnostic method that doctors sometimes use is magnetic resonance imaging, which allows you to find out in which metatarsal bone the fracture occurred.

Treatment

Treatment is conservative. It comes down to rest and unloading of the limb, its immobilization for 3-4 weeks. plaster bandage, the appointment of thermal physiotherapy, massage and physiotherapy exercises.

The prognosis is favorable.

Prevention consists in strict medical supervision of recruits (treatment of flat feet), as well as wearing well-fitted, rational shoes.

Prevention

In order to prevent the development of the disease, one should wear comfortable shoes with orthopedic insoles, regularly undergo preventive examinations, promptly identify and treat functional insufficiency of the feet, and exclude periods of long walking.

Preventive measures

One of the main reasons that increases the risk of a march fracture is a lack of calcium in the human body. This is due either to malnutrition or insomnia. Since the hormones that provoke the absorption of calcium into the bone are produced only during periods of sleep. Therefore, to prevent a fracture, it is necessary to eat right and have good sleep. Experts also recommend the following:

In order not to encounter a marching fracture, it is necessary to constantly control the load, increasing it gradually. If a person is engaged in different types of exercises, then they should be alternated, for example, running with cycling, strength training with swimming, etc. Muscles and bones should be given rest and time to recover from exercise.

During training, it is necessary to use high-quality and correct shoes, as well as elastic bandages.

Marching foot (Deichlander's disease) is a disease that occurs as a result of excessive load on the metatarsal bones. Pathology affects mainly people with low activity, who decide to perform excessive physical work. An unprepared body fails.

The pathology is not inflammatory or malignant. A marching fracture of the foot (code M84.4 according to ICD-10) can be acute or chronic.

The pathogenesis of the disease is associated with excessive load on the legs. The feet of a person are responsible for support and cushioning during movement. In untrained people, the bones cannot cope with an unusual load for them. Pathological changes are formed in the diaphyseal part of the metatarsus. II, III, rarely - IV, V metatarsal bones may be involved in the process.

Pathological changes in bone tissue are represented by lacunar resorption. Over time, the affected area is replaced by new cells. The pathological process disappears.

The opinion of professors of medicine about the name of pathological changes was divided. Some believe that an incomplete fracture is formed. Others call the change a microfracture. Most physicians agree that the name "marching fracture" is obsolete. Bone resorption occurs locally, over time it is independently replaced by bone tissue without complications. The disease is less common in soldiers. Widely spread among hairdressers, fashion models. They wear huge heels and are on the move all day long.

Causes and symptoms of marching foot

Pathological restructuring of bones in Deichlander's disease occurs under the influence of provoking factors.

According to medical statistics, common causes of the disease are:

strong physical activity ensures the development of pathology in untrained people;
walking long distances in uncomfortable shoes;
lack of physical fitness;
pathology occurs in recruits after a marching, less often military march;
congenital / acquired deformities of the foot can provoke the development of a marching fracture.

The risk group for the development of the disease are people of professions:

sellers, consultants in hypermarkets;
stylists, hairdressers;
tour guides;
handymen;
models, athletes;
health workers;
waiters;
skaters.

Tight shoes with high heels, the presence of flat feet, walking long distances provoke the development of a marching foot.

According to the international classification, there are two forms of pathology:

Acute - characterized by a sudden onset. On the 3-4th day, we observe the appearance of the first symptoms of a marching foot. Patients complain of acute pain in the middle of the foot, severe swelling in the area of pathology. The disease is not accompanied by fever or asthenovegetative syndrome (weakness, loss of appetite).
The primary chronic form of the marching foot is characterized by a slow course. After significant loads, patients note intense pain in the central part of the sole, swelling, swelling, redness. Increased sensitivity of the skin at the site of injury. Due to severe pain syndrome, gait is disturbed. The person begins to limp. The disease lasts for several months, then gradually the symptoms disappear.

Diagnostics

The diagnosis is based on:

Complaints of the patient on pain with specific localization.
Anamnesis of the disease: the first symptoms of the pathology appeared against the background of an unusual load.
History of life (the patient works in an area with intense physical activity on the legs).
Objective examination of the injury site: on palpation of the midfoot, the patient complains of sharp pain. On examination, there is swelling, swelling, redness.
An X-ray of the foot helps to confirm the diagnosis. The research method reveals the typical signs of Deichlander's disease, exclude osteomyelitis, tuberculosis, malignant tumor, purulent bone processes.

The X-ray picture depends on the duration of the disease. The main manifestations of pathology:

If the picture is taken a few days after the onset of the disease, pathological changes may not be observed. It is recommended to repeat the study in a week. The alternative is to do an MRI.
With a marching fracture, an oblique or transverse band of enlightenment is observed. The phenomenon is called the Looser zone. The metatarsal appears to be divided into two fragments. If a person breaks a bone, deformation, displacement is observed. With the disease, the listed phenomena are absent.
Over time, periosteal growths appear around the pathological area. Represented by thin formations, they begin to gradually thicken. The picture looks like a spindle-shaped callus. After a few weeks, the zone of enlightenment completely disappears. There is sclerosis of the affected area.
Periosteal layers dissolve. The structure of the metatarsal changes permanently. Becomes thick and dense.

It is radiography that helps to distinguish a marching fracture from other traumatic injuries. In pathology, the correct shape of the metatarsus is preserved, there is no displacement of fragments, an area of inflammation.

Treatment Methods

Treatment of a marching foot begins with diagnostic measures (X-ray, MRI). After confirmation of the diagnosis, conservative therapy is started:

Doctors prescribe bed rest for the patient.
It is forbidden to give intensive loads on the legs. You can not stand or walk for a long time.
Plaster splints are being adjusted to restore the integrity of the feet.
The patient should go to therapeutic exercises, massage.
Physiotherapy is prescribed to relieve the typical symptoms of the disease.
Medications are used to reduce the manifestations of pain. Painkillers, cooling ointments, topical balms are prescribed.
You should wear orthopedic shoes for a long time, special insoles to prevent complications.

Surgical methods of treatment for pathology are not used. The microfracture heals on its own.

Appeal to traumatology

The disease is treated in the traumatology department. In the acute form, traumatologists apply a plaster splint for 10 days. The medical device contributes to the restoration of the physiological structure of the bone. Longet provides rest to the affected limbs.

Primary chronic marching foot is treated with massages, physiotherapy.

In stationary conditions, to relieve pain, the patient is prescribed:

Ketorolac fights pain, inflammation. The drug inhibits the activity of COX-1, COX-2. The latter are responsible for the synthesis of prostaglandins. Inflammatory mediators are not formed and unpleasant symptoms disappear. Ketorolac does not affect sleep and breathing, copes with pain better than many NSAIDs. Assigned to 10 mg up to 4 r / day. The drug is taken under medical supervision.
Metamizole sodium (analgin) has similar actions. Used to relieve pain of various origins. The medicine should be taken 1-2 tablets 2-3 r / day after meals.
Additionally, calcium preparations are prescribed. The macroelement contributes to the rapid strengthening of the metatarsal bone.

After discharge, the patient should use orthopedic shoes, avoid excessive loads.

Physiotherapy and massage

In case of pathology, doctors prescribe long courses of massage to patients. The technique helps to relax the tense muscles of the legs and feet. Thanks to massage movements, blood circulation in the structures of the musculoskeletal system improves, active / passive movements in the joints are restored.

After 2-3 procedures, patients note a decrease in the severity of the pain syndrome. Methods, technique of manipulation is determined by the individual condition of the patient. Apply therapeutic, segmental-reflex massage. Doctors recommend continuing the procedure at home after discharge from the hospital for 3-6 months.

Physiotherapeutic methods are used to treat Deichlander's disease. Positive dynamics is observed when using electrophoresis, magnetotherapy, paraffin applications, ozocerite. Procedures improve blood circulation in the place of pathology, increase regeneration processes.

home remedies

Alternative methods of treatment are used in the complex treatment of fractures, bruises, and other injuries of the limbs. Home recipes accelerate the healing of injuries, relieve pain. Below are some effective tinctures to combat the disease:

Representatives of traditional medicine recommend eating 2 walnuts daily to strengthen the joints.
Powdered eggshell film contains many nutrients. Improve the functioning of the musculoskeletal system, internal organs. The medicinal drug is taken with lemon juice. The course of treatment is until the general condition of the patient improves.
Make healing compresses with ½ tsp of salt and raw egg yolk. Mix the two ingredients, put on a napkin. Attach to the pathological site. Secure with a bandage. Walk around with a bandage all day long. Apply compresses until the pain disappears.

Possible Complications

In most cases, it goes unnoticed. Sometimes complications develop. Untimely treatment of the disease leads to serious consequences:

hypertrophic bone changes;
involvement in the pathological process of nerves, which is manifested by a pronounced pain syndrome;
restriction of movements in the foot;
occurrence of osteoporosis. Pathology leads to frequent fractures;
erysipelas purulent inflammation appears on the marching foot, when the bacterial flora enters the lesion. There are typical signs of erysipelas (painful redness, high body temperature). After a trauma hospital, the patient enters the infectious diseases department for the treatment of erysipelas;
inflammatory changes in the bones can pass to the ligaments, tendons. Tendovaginitis develops;
ulcers appear when the integrity of the skin in the area of \u200b\u200bpathology is violated. Complications are treated with antibiotic ointments.

Self-squeezing pus is strictly prohibited!

Marching foot is a pathological condition that appears as a result of excessive load on the feet. Sick soldiers, guides, athletes, hairdressers.