Fatigue fractures of the foot

While fatigue fractures are common in military practice they are much less so in civilian practice and thus tend to be overlooked. Fractures occur most commonly in the distal second and third metatarsal shafts and within the calcaneum, but occur in almost any other bone of the foot. Any suspicious history of repetitive stress or sudden change in activity, athletic or otherwise, associated with swelling and point tenderness warrants further investigation by bone scintigraphy. Attention is drawn to the importance of understanding the basic biomechanical function of the foot and how it may affect the development of fatigue fractures. A distinction is drawn between the distal fractures of the second and third metatarsal shafts and those occurring in the proximal shafts of any of the metatarsals which have a different aetiology. Following conventional management in a plaster cast, it is suggested that any biomechanical anomaly which is present is compensated appropriately with an orthotic insole.