Marching foot treatment. March fracture of the metatarsal bone: Anatomy, Causes, Symptoms, Treatment, Prevention. Review of Key Symptoms

A march fracture is a structural deformity metatarsal, which a person can get after uneven loads on the foot.

People who prefer to lead an active lifestyle, play sports (most often running), and girls who wear high-heeled shoes are at risk for this injury.

The name of the injury is associated with marching military personnel, who suffer from this problem more often than anyone else, as they constantly engage in active training and forced marches.

Another name for the march fracture injury is Deichlander's disease, which develops on the second metatarsal bone. She's like most existing pathologies and injuries, is associated with great inconvenience in Everyday life, however, doctors talk about a favorable prognosis.

Causes of the problem

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

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

Whichever physical activity no matter what a person does, 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, people often get an injury called a “march fracture” while on vacation. Practically all year round Leading a passive, sedentary lifestyle, when they go on vacation they decide to change something radically: start jogging along the beach in the morning or walking around local attractions. The foot, in turn, is not prepared for such changes, so it suffers from severe 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 tripping on an uneven surface, risking falling and damaging herself. But inept movement in heels is not a guarantee of injury. Long-term wearing of such shoes entails overload of the metatarsus, deformation of the foot and fracture of the metatarsal bone, even in comfortable ballet shoes.

Many will agree that professional sport is not so much about health, but, on the contrary, about risks and losses. Thus, many athletes, especially during the period of intensive preparation for upcoming competitions, train for six or even more hours a day. This is a very large load on all organs and systems, so this category of people needs to visit a specialist regularly, every six months, for a full examination.

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

To summarize, we can highlight 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.

Review of Key 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 severely felt while walking;
feeling of uncertainty when walking;
lameness that lasts for several months;
swelling of the feet;
pain in the area of the damaged metatarsus, felt upon palpation.

Unlike other injuries, marching fractures are not associated with symptoms such as: redness of the skin in the area of injury, increased body temperature, subcutaneous hemorrhages, and changes detected in a blood test.

Diagnostic features

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

According to this division, doctors call three groups:

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

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

In addition, provided proper treatment, the risk of encountering the consequences of 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 as soon as possible, who will conduct an appropriate study.

Among the methods used for diagnosis, the following are primarily mentioned:

palpation - feeling the patient’s body, in particular the place that hurts;
visual inspection;
interviewing the patient for complaints;
laboratory research.

After this, the doctor will be able to make a diagnosis and prescribe effective ones in a particular case. medical supplies(stimulating healing bone tissue, eliminating pain and discomfort) and physiotherapeutic procedures.

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

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

X-rays show such a fracture only after five to seven weeks, which is why Deichlander's disease is called a hidden pathology.

How, then, to carry out diagnostics? Let's 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 them to find out which metatarsal bone the fracture occurred in.

The need for MRI arises if palpation causes sharp pain, and in the area of localization there is slight inflammation.

Specific Treatments

Doctors do not offer any special treatment methods for a march fracture, since with any similar injury naturally appears callus, that is, healing and fusion.

The only thing a person can do is to help his body by leaving it alone and relieving the damaged limb of unnecessary stress. There is no need to immobilize the limb for such a fracture.

You can use special orthopedic insoles, facilitating the removal or proper distribution of the load. With their help, it is easier to endure the healing process and speed up bone fusion.

If necessary, painkillers and anti-inflammatory drugs are prescribed medications(ointments, creams and tablets).

A marching fracture is one of the safest injuries of this kind, but you should not treat it with disdain. Competent diagnosis and treatment will help you get rid of pain syndrome faster.

The word “fracture” most often means an acute disease with characteristic symptoms. It is usually preceded by trauma (fall, blow, collision with a car, etc.). However, few have heard about the marching fracture of the foot (Deichlander's disease, stress fracture). Moreover, most people do not suspect that they themselves are faced with this disease.

What can cause a marching fracture of the metatarsal bone can be understood from the name of the disease. The disease was first described in army recruits. A sudden change of environment, intense physical activity, uncomfortable shoes and, of course, marching with a clear step - all this provokes the formation of small cracks in the thickness of the metatarsal bone.

Normally, the body can restore everything on its own within a few days, but this requires rest. If unfavorable factors are repeated daily, then regeneration simply cannot cope and the metatarsal bone suffers more and more.

You should not think that march fractures only threaten soldiers. In addition to them, several risk groups for the formation of marching foot can be distinguished:

Tourists traveling hundreds of kilometers on foot with huge luggage on their shoulders.
Professional athletes who push their bodies to the limit in daily training.
Long-term lovers hiking on fashionable shoes with high heels. In this case, the foot loses its shock-absorbing properties, and the maximum load falls on the thin metatarsal bones.
Representatives of professions who long time standing on their feet: sellers, hairdressers, tour guides, bartenders, waiters, etc.
Persons with osteoporosis (decreased bone density) - sometimes a slight load is enough to develop the marching foot.

How does marching foot manifest clinically?

If with an ordinary fracture the symptoms are pronounced and increase over several tens of minutes, then with march sickness everything is far from the same.

The main symptom of a marching fracture is pain in the middle of the foot.. In this case, pain can be of two types:

Acute pain - appears literally a few days after a significant load on the foot. The patient can easily associate these two events, which helps early diagnosis such a fracture.
Chronic pain is much more common than acute pain. It starts out as a minor unpleasant sensation after noon. Gradually, the pain in the marching foot increases and worries throughout the day. Painful sensations localized over the damaged bone.

There are a total of 5 metatarsal bones in the foot, each of which is located behind the corresponding toe and is a thin tube. The 2nd and 3rd metatarsal bones are most susceptible to march fractures.
By pressing on the skin, the patient himself can easily determine in which place of the foot the symptom is most pronounced, which indicates the approximate location of the fracture.

Diagnostic methods

If you do X-ray examination In the first weeks after physical activity and the onset of pain, nothing may be detected. At typical fracture the cortical layer of the bone is damaged and displacement often occurs, which is clearly visible in the image. A marching fracture is a local damage to the bone, the pain is localized in the center, and a slow restructuring of its structure is observed.

Characteristic signs of a march fracture on an x-ray:

The cleared area in the form of a strip located across the bone is the zone where, as a result of restructuring, the old tissue does not have time to be replaced by new tissue in a timely manner.
At first glance at the marching foot, you may get the impression that the bone is divided into 2 parts, differing from each other in their structure. They are never displaced relative to each other. Displacement of bone fragments is always a sign of an ordinary traumatic fracture.
Around the area of enlightenment, the bone may change its shape and resemble a spindle. This is a consequence of constant regenerative processes. A doctor, seeing such a thickening, may regard it as a formed bone callus - a consequence of an old fracture.

Tomography is more expensive, but informative method in determining a march fracture, since it allows you to examine the bone layer by layer and identify pathology even in its very center.

Treatment of a march fracture

Marching foot is not fatal and does not require emergency radical measures. Typically, doctors use conservative methods.

The main thing is to eliminate the impact of the unfavorable factor that provoked march sickness. The patient is freed from any physical activity that involves prolonged support of the foot.
Plaster splint - allows you to relieve the metatarsal bones and prevent unnecessary movements in the limb, providing maximum rest to the affected organ.
Special orthopedic insoles or shoes rationally redistribute the load on the walking foot in such a way that the nearby bones take over everything and provide conditions for recovery.
Physiotherapy – electrophoresis, magnet, ozokerite. All these procedures speed up regeneration and reduce pain.
Locally, you can use gels and ointments with painkillers and anti-inflammatory drugs. This allows you to quickly eliminate pain and eliminates the need to take pills orally (all anti-inflammatory drugs are harmful to the stomach).
Calcium preparations supply the body with building material necessary for bone restoration.

Rehabilitation

The course of treatment for a march fracture lasts approximately 3–4 weeks, after which the doctor takes a control X-ray. If there are signs of restoration of bone strength, then rehabilitation measures begin.

Massage allows you to relax the muscles of the lower leg and foot, which makes it possible to restore range of motion and reduce discomfort.
Physio therapeutic methods– Apply approximately the same as at the treatment stage.
Physiotherapy.
The patient needs to use for a long time after a march fracture. orthopedic shoes, to prevent relapse.

Possible complications

If a person does not pay attention to pain or simply takes analgesics, continuing to subject the body to excessive stress, then with a large share Most likely, marching foot can lead to the following complications:

Significant hypertrophy of the metatarsal bones in areas located closer to the toes. As a result, nerve branches may become involved in the process and pain may increase significantly.
The development of osteoporosis and a predisposition to a common fracture, even with minor trauma.
Arthrosis small joints foot is a progressive degenerative disease that is usually diagnosed in older patients. Deformation of the arch of the foot at a young age, can provoke the destruction of articular cartilage. This does not threaten human life, but its quality suffers greatly.

People at risk need to remember about such a disease as a march fracture and seek help when the first signs appear. It is very important to monitor the quality of shoes and try to purchase those models that provide the most physiological position. Beauty requires sacrifices, but these sacrifices must be reasonable!

Due to excessive load on lower limbs Some people may develop a pathology called marching foot. IN medical reference book this disease is also listed as march fracture or Deichlander's disease. It is also called a disease of recruits who are not accustomed 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 their service, people whose occupation involves constant standing, long walking or carrying heavy loads), this pathology may be a consequence 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 activities, may experience this structural change stop.

New conscripts.

Young people find themselves in unusual conditions:

uncomfortable shoes;
excessive exercise stress caused by daily long-term training (running, forced marches, strength exercises).

These conditions adversely affect the condition of the thin, very vulnerable bones of the foot. Prolonged and excessive pressure can cause a fracture. The 2nd metatarsal bone is most susceptible to change; sometimes the marching foot involves the 3rd and 4th. Fractures of the 1st and 5th metatarsal bones are much less common. Please note that the pathology is even named after this group “marching”, that is, because of the grueling marches.

Professionals and lovers of tourist recreation.

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

True, tourists are not only vacationers in the lap 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. Under no circumstances should you wear such shoes; for long walks you should purchase comfortable, loose, soft, flat shoes.

There is a high risk of breaking the thin bones of the foot
among professional athletes

There is a high risk of getting a fracture of the thin bones of the foot during grueling training in preparation for competitions. Pathology can develop in athletes who have not exercised for some time and then returned to action. Sometimes the reason may be a change in the model of sports shoes.

Permanent employment

At risk are professions that require long stay on foot:

hairdressers;
sellers;
bartenders, waiters, cooks;
movers;
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, developing against the background of changed external factors and under the influence of constant functional overload of the foot. The pathology should not be considered as inflammatory or oncological.

Symptoms

The first sign of a disorder is pain. It can be acute or primary chronic, in the first case it is bright pronounced symptom, in the second – less pronounced:

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

When a march fracture occurs, pain appears
sensation in the midfoot

Pain appears in the middle part of the foot, sometimes unbearable and intense. As a result, a person tries to put less stress on the injured limb, the gait changes, and lameness appears.

From visible symptoms Let us note the formation of swelling of the foot in the area of the metatarsal bones of varying intensity: where the fracture is, the swelling is denser.

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

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

Diagnostics

Pain and swelling, as obvious 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 closed fracture. However, a traditional X-ray may not be enough because the image will not show the characteristic fracture lines.

Violation of the integrity of bone tissue occurs internally, while the surface of the bone remains seemingly untouched (the fragments remain connected by a thin layer of bone tissue). A clear identification of a march-type fracture using x-rays can be discerned only after a month and a half.

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

An MRI is also prescribed to diagnose a metatarsal fracture. The study is especially effective for fresh ruptures.

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

Observed initial signs restructuring of the structure of the diaphysis and the surrounding periosteum. In a cross section or slightly obliquely, a homogeneous clearing 1-3 mm wide is visible. A periosteal bone callus is formed around the diaphysis in the clearing zone (locally or involving the entire diaphysis).
Strengthening of periosteal layers, acquisition bone structure with pronounced signs of layering. Dense layers are less visible on x-rays.
The radiolucency is not visible on the radiograph due to excessive periosteal layering. The diaphysis thickens and becomes deformed, especially in the zone of restructuring. Painful sensations are smoothed out.
Gradual resorption of periosteal layers, the structure of the diaphysis is restored. In the image, the diaphysis appears thickened, but clear and with smooth edges.

Therapeutic effect

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

During the treatment period, the patient is provided with conditions for maximum limb rest;
overlay plaster cast for a period of at least a month;
physiotherapy;
massage;
orthopedic shoes or orthopedic insoles for shoes;
local medications (ointments, gels) for pain relief and to relieve swelling.

If the treatment rules are followed, patients can fully recover and return to their normal lifestyle.

Marching feet - no fatal disease, But this violation can bring discomfort into everyday life. You need to monitor the quality of your shoes, do not overdo it with physical activity, and if signs appear pathological condition do not hesitate to contact a specialist.

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Marching foot is a disease associated with pathological changes in the structure of the metatarsal bones, which are caused by excessive load on the foot.

This disorder is also commonly called marching fracture, overloaded foot or Deichlander's disease. The disease is not a tumor or inflammatory process.

This is a type of pathological restructuring of diaphyseal bone tissue ( central department tubular bone). A special study reveals local lacunar resorption of bone tissue, followed by its replacement with new bone structures.

The metatarsal bones are the most vulnerable part of the foot. With a march fracture, the 2nd bone is most often affected, less often - 3 and 4, 5 - very rarely. 1 bone is never affected at all due to the fact that it has a higher density.

Often only one metatarsal bone is damaged, but sometimes simultaneous damage is diagnosed or with the gradual involvement of several bones in this process.

Provoking factors

The main predisposing factor to the development of this disease is. Also among the reasons are:

The risk group includes recruits who, when entering a new environment for them, find themselves completely unprepared for long-term intense training, people whose professions involve standing on their feet, carrying heavy objects, and professional athletes.

Very often there are cases when a person goes on a hike without proper preparation and, while walking for a long time and carrying a heavy load, becomes a victim of this disease.

Clinical picture and forms of the disease

There are two forms of Deichlander's disease:

acute- occurs 2-4 days after exposure to stress (a rarer form);
primary chronic- develops slowly and incrementally.

Patients experience severe pain in the central part of the foot, which are sometimes simply unbearable. In this case, the gait is disrupted, the person begins to limp and tries not to step on the sore leg.

As a result of examination, dense swelling and edema are detected in the affected area (on outside Feet). The sensitivity of the skin in this area increases. Redness of the skin is rare.

An interesting fact is that with Deichlander's disease there is no characteristic symptoms, such as, heat or a change in the biochemical picture of the blood.

The average time for the development of the disease is several months, but it can pass much faster. Pain is present throughout the course of the disease.

Establishing diagnosis

The march fracture has a fairly clear clinical picture and cannot proceed latently, so the patient, experiencing severe pain and discomfort, immediately consults a doctor.

First of all, an x-ray and an initial examination are used to make a diagnosis.

Since the marching foot is a closed pearl, an x-ray may not be enough due to the fact that the characteristic fracture lines will be absent in the image (especially at the onset of the disease).

If the image does not give any result, the specialist uses the palpation method. The diagnosis will be obvious if there is, and also if, while palpating the foot, the patient feels severe, sharp pain.

Sometimes magnetic resonance imaging is used to diagnose damage to the metatarsal bones; this method will be especially relevant for recent damage.

There are also several stages pathological changes metatarsal bones, which are taken into account when making a diagnosis:

Are revealed primary signs transformation of the structure of the diaphysis and periosteum which surrounds him. In a cross section or slightly obliquely, a uniform clearing with a diameter of several millimeters will be visible. An external one is formed around the diaphysis in the area of clearing.
Increase in external layers, acquisition of bone structure with clear signs layering. Dense layers are poorly visible on x-rays.
The radiolucency is not visible on x-ray due to excessive external layering. The diaphysis becomes thickened and deformed. The pain becomes less intense.
External layers gradually dissolve, the structure of the tubular bone section is restored; the X-ray image will show a thickening with clear, smooth edges.

Approach to therapy

For a fatigue cruising fracture, it is used conservative treatment. The goal of therapy is to relieve acute pain symptoms and eliminating the underlying mechanism that triggered the disease. Surgical intervention in this case it never applies.

First of all, a plaster splint is placed on the patient’s foot and prescribed bed rest, which should be at least a week. The person must be freed from prolonged standing and walking, because the injured leg needs complete rest. After the pain becomes less intense, the following methods can be used:

massage;
thermal baths;
paraffin or ozokerite applications;
ointments and gels with a warming effect (for example, Fastum-gel);
Sometimes non-steroidal drugs are prescribed to relieve swelling and eliminate pain: Aspirin, ;
foot baths using sea salt or with herbal mixture;
physiotherapy to relax the lower leg muscles, while the exercises should not involve the feet.

also in mandatory V rehabilitation period The patient is prescribed to wear arch supports.

What could all this lead to?

Conservative therapeutic methods always give excellent results in the treatment of marching foot, but in no case should the course of the disease be left to chance. Lack of proper treatment and rehabilitation can lead to changes anatomical features foot and dysfunction.

What complications may occur with this disease:

Preventive actions

After treatment, in order to avoid relapses, the patient will need to adhere to the following rules:

in the near future, give up long walks over too long distances;
avoid standing for long periods of time;
exclude those sports that will have a strong impact on the lower limbs (for example, running);
wear only comfortable shoes, flat platforms should be excluded, shoes with a slight elevation and an internal soft cushion in the area of the instep will be relevant;
at the end of the day, take relaxing foot baths;
systematically undergo a course of special massage.

The prognosis for a marching foot fracture is always favorable. If the problem is detected in a timely manner and promptly addressed medical care, you can achieve the fastest possible cure.

It is always worth remembering that when going on a serious hiking trip, which involves heavy loads without preliminary preparation, it is forbidden. Also, people who have suffered such an injury are recommended to change their type of activity, which involves standing on their feet, carrying heavy objects, or constantly moving over long distances.

A marching fracture is not a reason to forget about sports and, in general, about an active lifestyle; the main rule is that any physical activity should be moderate.