Sequential metatarsal stress fractures after Keller arthroplasty with implant

The occurrence of single stress fractures after Keller arthroplasties has been documented. This paper presents a case of sequential stress fractures of metatarsals two and three after Keller arthroplasty with hemi-phalangeal implant. It is the author's view that failure to recognize and properly treat the fracture of the second metatarsal led to the additional fracture of the third metatarsal. Furthermore, the use of a nonrigid orthotic with metatarsal padding is recommended postoperatively to decrease the probability of this complication.