The influence of second toe and metatarsal length on stress fractures at the base of the second metatarsal in classical dancers

Stress Fractures of the Foot

Stress fractures of the foot and ankle may be more common among athletes than previously reported. A low threshold for investigation is warranted and further imaging may be appropriate if initial radiographs remain inconclusive. Most of these fractures can be treated conservatively with a period of non-weight-bearing mobilization followed by gradual return to activity. Early surgery augmented by bone graft may allow athletes to return to sports earlier. Risk of delayed union, nonunion, and recurrent fracture is high. Many of the patients may also have risk factors for injury that should be modified for a successful outcome.

A THREE-DIMENSIONAL MORPOLOGICAL MEASUREMENT AND IN VITRO BIOMECHANICAL STUDY OF METATARSALS

Stress fracture of the metatarsal (MT) is often reported clinically. This study was aimed to measure and compare the three-dimensional (3D) morphological structure of five MTs, and investigate the in vitro biomechanics of five MTs under simulated stance phase. A total of seven foot-ankle samples of human cadavers were collected for this experiment. All samples were CT-scanned and 3D re-constructed for digital measurements. To simulate the stance phase, each sample was vertically loaded with 700-N through a material testing machine. The 3D-reconstruction-based measurement showed significant differences of the shaft length, vertical height, and inclination angle between the second MT and four others. Experimental strain measurements at dorsal MTs along the principal axis are all compressive. The values are respectively [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] micro-strain from the first to fifth MTs. This study proposed a new load condition of plantar-flexed simply supported beam to describe the MT loading mechanism. The second and third MTs have higher risk of stress fracture due to combined effects of inhomogeneous load distribution, unfavorable geometry and structure, and limited joint motion. This finding would be helpful for design of protective equipment.

Study of the metatarsal formula in patient with primary metatarsalgia

Objectives

The aims of this study were (i) to ascertain the prevalence of different types of metatarsal formula among patients with primary metatarsalgia; (ii) to compare the variable of “shortening of the first metatarsal in relation to the second” (I/II) between the metatarsalgia and control groups; and (iii) to analyze the intra and interobserver concordance by means of Morton's transverse line method and Hardy and Clapham's arc method.

Methods

A cross-sectional observational study was conducted on 56 patients by means of radiographs on their 112 ft, of which 56 were in the metatarsalgia group and 56 in the control group. The evaluations were done between December 2012 and June 2013. The measurements were made by three third-year orthopedics residents with prior training in the methods used, and a template was used.

Results

There was no concordance between the two methods, as shown by Bland–Altman plots, although the intraclass correlation coefficients showed that the intra and interobserver reproducibility was high using the transverse line method (0.78 and 0.85) and moderate using the arc method (0.73 and 0.60). Comparison between the groups showed that there was a statistical difference (p ≤ 0.05) such that there was greater shortening of the first metatarsal (3.39 mm) in the control group than in the metatarsalgia group (2.14 mm). In the patients with primary metatarsalgia, the index minus metatarsal formula was more prevalent according to the transverse line method (62.5%) and the zero plus type according to the arc method (71.4%).

Conclusion

In the present study, it was observed that the metatarsal formula prevalences depended on the measurement method. In both groups, shortening of the first metatarsal predominated. There was no intra or interobserver concordance in either of the two proposed methods.

Overuse Injuries in Professional Ballet: Injury-Based Differences Among Ballet Disciplines

Background

Despite overuse injuries being previously described as the most frequent in ballet, there are no studies on professional dancers providing the specific clinical diagnoses or type of injury based on the discipline.

Hypothesis

Overuse injuries are the most frequent injuries in ballet, with differences in the type and frequency of injuries based on discipline.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

This was a descriptive cross-sectional study performed between January 1, 2005, and October 10, 2010, on injuries occurring in professional dancers from leading Spanish dance companies who practiced disciplines such as classical, neoclassical, contemporary, and Spanish ballet. Data, including type of injury, were obtained from specialized medical services at the Trauma Service, Fremap, Madrid, Spain.

Results

A total of 486 injuries were evaluated, a significant number of which were overuse disorders (P < .0001), especially in the most technically demanding discipline of classical ballet (82.60%). Injuries were more frequent among female dancers (75.90%) and classical ballet (83.60%). A statistically significant prevalence of patellofemoral pain syndrome was found in the classical discipline (P = .007). Injuries of the adductor muscles of the thigh (P = .001) and of the low back facet (P = .02) in the Spanish ballet discipline and lateral snapping hip (P = .02) in classical and Spanish ballet disciplines were significant.

Conclusion

Overuse injuries were the most frequent injuries among the professional dancers included in this study. The prevalence of injuries was greater for the most technically demanding discipline (classical ballet) as well as for women. Patellofemoral pain syndrome was the most prevalent overuse injury, followed by Achilles tendinopathy, patellar tendinopathy, and mechanical low back pain.

Clinical Relevance

Specific clinical diagnoses and injury-based differences between the disciplines are a key factor in ballet.

Intra-observer reliability for measuring first and second toe and metatarsal protrusion distance using palpation-based tests: a test-retest study

BACKGROUND

Measurement of first and second metatarsal and toe protrusion is frequently used to explain foot problems using x-rays, osteological measurements or palpation-based tests. Length differences could be related to the appearance of problems in the foot. A test-retest design was conducted in order to establish the intra-rater reliability of three palpation-based tests.

METHODS

202 feet of physical therapy students and teachers of the CEU San Pablo University of Madrid, 39 men and 62 women, were measured using three different tests. Data were analysed using SPSS version 15.0. Mean, SD and 95% CI were calculated for each variable. A normal distribution of quantitative data was assessed using the Kolmogorov-Smirnov test. The test-retest intra-rater reliability was assessed using an Intraclass Correlation Coefficient (ICC). The Standard Error Mean (SEM) and the Minimal Detectable Change (MDC) were also obtained.

RESULTS

All the ICC values showed a high degree of reliability (Test 1 = 0.97, Test 2 = 0.86 and Test 3 = 0.88) as did the SEM (Test 1 = 0.07, Test 2 = 0.10 and Test 3 = 0.11) and the MDC (Test 1 = 0.21, Test 2 = 0.30 and Test 3 = 0.31).

CONCLUSIONS

Reliability of measuring first and second metatarsal and toe protrusion using the three palpation-based tests showed a high degree of reliability.

Proximal base stress fracture of the second metatarsal in a Highland dancer

A 15-year-old female Highland dancer presented to the accident and emergency department with an ankle inversion injury on a background of several weeks of pain in the right foot. A radiograph of the right foot demonstrated a stress fracture at the base of the second metatarsal. She was treated conservatively with a below knee removable supportive walking boot with a rocker bottom sole. She re-presented to the accident and emergency department 3 weeks later with pins and needles in the right foot; she was given crutches to use along side the supportive walking boot. Radiographs 12 weeks after the first presentation showed healing of the stress fracture. The patient was now asymptomatic of the injury. She was unable to fully train for 12 weeks due to the injury. Conservative management was successful in this patient.

Post-operative stress fractures complicating surgery for painful forefoot conditions

A stress fracture is caused by repetitive or unusual loading of a bone leading to mechanical failure. Fatigue type stress fractures occur in normal bone exposed to abnormally high repetitive loads, whereas insufficiency type stress fractures occur in abnormal bone exposed to normal loads. We describe three cases of insufficiency stress fractures that have complicated surgery for painful forefoot conditions. The diagnosis and management of these cases are discussed. Stress fractures should be included in the differential diagnosis of any patient who continues or develops pain after surgery to the forefoot.

Injury patterns in female Irish dancers

OBJECTIVE

To determine the type of Irish dance injuries requiring evaluation and treatment by a sports medicine physician.

DESIGN

Cross-sectional retrospective chart review.

SETTING

Academic sports medicine center in the Midwest.

PARTICIPANTS

Female Irish dancers who presented at an academic sports medicine center from June 2002 to September 2009.

MAIN OUTCOME MEASURES

This was a retrospective chart review identifying injuries sustained to female Irish dancers in a single Irish dance company in a major metropolitan area. Dancers were evaluated and injuries were diagnosed by one sports medicine physician at an academic sports medicine center.

RESULTS

Sixty-nine female Irish dancers, ages 8 to 23 years, sustained 217 recorded injuries. The top injuries included stress fractures (29.9%), patellofemoral pain syndrome (11.1%), Sever condition (6.0%), ankle sprains (5.1%), posterior tibialis tendonitis (4.6%), and plantar fasciitis (4.6%). The most common site for stress fractures were the sesamoids, comprising 27.7% of all stress fractures and 8.3% of total injuries. The majority of injuries were in the lower extremities (94.9%), remaining injuries involved the lumbosacral spine and pelvis (5.1%). Most dancers (79.7%) had multiple injuries. The number of injuries per dancer increased as the dancer's level increased. There was a trend for the average age of the dancers to decrease as the level of skill increased.

CONCLUSION

Lower extremity injuries comprised the majority of Irish dance injuries. Stress fractures (29.9%), patellofemoral pain syndrome (11.1%), and Sever condition (6.0%) were the most common injuries.

The Reliability and Validity of a Three-Camera Foot Image System for Obtaining Foot Anthropometrics

The purpose was to develop a foot image capture and measurement system with web cameras (the 3-FIS) to provide reliable and valid foot anthropometric measures with efficiency comparable to that of the conventional method of using a handheld anthropometer. Eleven foot measures were obtained from 10 subjects using both methods. Reliability of each method was determined over 3 consecutive days using the intraclass correlation coefficient and root mean square error (RMSE). Reliability was excellent for both the 3-FIS and the handheld anthropometer for the same 10 variables, and good for the fifth metatarsophalangeal joint height. The RMSE values over 3 days ranged from 0.9 to 2.2 mm for the handheld anthropometer, and from 0.8 to 3.6 mm for the 3-FIS. The RMSE values between the 3-FIS and the handheld anthropometer were between 2.3 and 7.4 mm. The 3-FIS required less time to collect and obtain the final variables than the handheld anthropometer. The 3-FIS provided accurate and reproducible results for each of the foot variables and in less time than the conventional approach of a handheld anthropometer.