Marching fracture of the foot. Marching foot - stress fracture caused by lifestyle

A marching fracture is characterized by swelling and pain in the forefoot. Therefore, it used to be called a “tumor of the foot,” and only an x-ray study, which revealed transverse lines of clearing in the metatarsal bones, most often in the second or third, gave reason to think about a kind of fracture without trauma.

Since a march fracture was more often found in recruits after marching, and radiographs gave the impression of a fracture of the metatarsal bones, it began to be called a march fracture. Later it became known that changes in the metatarsal bones have nothing in common with ordinary fractures, which was first reported by Deutschlander, which is why this disease is often called by his name. This disease often affects civilians, with women more often than men.

Symptoms of a march fracture

The disease begins either acutely - immediately after a large overload of the foot, or gradually - pain develops in the forefoot, interfering with walking. There is a very dense, painful swelling on the back of the foot. Radiologically detectable changes in a march 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 clearing is found, enveloped in a fusiform thickening of ossified periosteum.

It is now generally known that the march fracture is one of the localizations of the zones of restructuring described by Looser. The reason for the restructuring is excessive mechanical overload of the bone tissue. Such bone overload can occur not only as a result of a significant excess of the normal load, as is observed in athletes during competitions, during overtraining, but also when normal load in unfavorable functional conditions, for example when walking in high heels, with flat feet or with decreased endurance of bone tissue (rickets). IN the latter case zones of restructuring usually arise at the apex of the curvature of the femur or tibia, i.e., in places subject to the greatest mechanical force “for fracture”, or in the area of the femoral neck with coxa vara, where mechanical force “for fracture” acts.

Under normal conditions physical work or training, gradual hypertrophy of the loaded parts of the skeleton occurs, as is usually observed in individuals physical labor, athletes or ballerinas. In the latter, hypertrophy of the predominantly loaded third metatarsal bones is especially noticeable. With excessive, unbearable load on the bones, exceeding normal reparative capabilities, restructuring processes develop. If the etiological factor of the restructuring - mechanical overload of the bone - is proven, then the pathogenesis of the restructuring remains unclear. G.I. Turner, putting forward the neurotrophic theory, considered bone remodeling during marching fractures to be a secondary act, which is a consequence of primary irritation of the nerves under the influence of prolonged fatigue of the tense muscular and ligamentous apparatus. The author saw confirmation of his theory in numerous symptoms of sensory, vascular and trophic disorders. Meaning nervous system A. N. Kurachenkov and V. F. Krukovskaya support the emergence of zones of restructuring in bones.

Some believe that the primary factor in bone remodeling is the summation of microtraumas, which entails molecular shifts and even microfractures.

The pathoanatomical essence of a march fracture is limited resorption of bone substance with the subsequent replacement of the old bone with a new one. Initially, the restored bone is low in lime, but later a dense, compact bone is created. The periosteal reaction is especially pronounced. At the end of the restructuring, which lasts from 3 to 5 months, the metatarsal bone usually regains its original shape, the fusiform thickening disappears, but the bone remains thicker and denser.

The final favorable outcomes of reconstruction in the area of the Loozerov zones give reason to consider them as a rational resection of bone tissue under excessive load, since as a result of the restructuring the bone becomes more durable and adapted to new static-dynamic conditions. We have to observe a significant strengthening of the metatarsal and other bones after the formation of zones of restructuring.

Treatment of march fractures

Treatment in acute stage comes down to making a posterior plaster splint for the shin and foot with well-modeled arches. Initially needed for a few days bed rest, and then walking on crutches is allowed for up to 2 weeks. At the same time, warm foot baths, paraffin baths, etc. are used. After acute symptoms have been eliminated, the patient begins to walk with a load in a plaster boot with a well-modeled sole. When walking in a plaster boot becomes completely painless, you can use orthopedic shoes or even an insole.

Prevention marching fractures is proper training, wearing rationally constructed and well-fitting shoes.

The article was prepared and edited by: surgeon

A marching fracture is a damage to the metatarsal bone that occurs as a result of excessive and prolonged physical activity on the foot. Marching foot It can also occur in people who wear “wrong” shoes, which redistribute the load on the forefoot and thereby overload it. Metatarsal fractures are accompanied by pain and swelling of the soft tissues of the foot.

Causes of marching foot

Causes of a marching foot fracture

Conscripts are considered first on the list of those most susceptible to a march fracture of the metatarsal bone. Harsh army conditions, unusual shoes, sudden overwhelming physical exertion and exhausting forced marches - all this creates unbearable conditions for the vulnerable and thin bones of the foot; they break from excessive and prolonged pressure.

The second metatarsal bone suffers the most, while the third and fourth suffer slightly less. Very in rare cases The first and fifth metatarsal bones of the foot are fractured. This fracture was even named after the soldiers who selflessly march on military service and break the bones of the feet.

Tourists are at risk of a march fracture

The risk group for marching foot fractures includes tourists who experience excessive stress on their legs during vacations and travel, while sightseeing, walking, shopping, and so on. The feet of women who prefer heels are especially affected, even during relaxation. Their metatarsal bones break, unable to withstand the extreme strain.

Marching foot often occurs in avid athletes, both men and women, with extensive experience and sports experience. The reason for this may be intensive preparation for competitions, a change in the style of sports shoes, difficult exercises after a long break, or without prior preparation.

This unpleasant disease also accompanies representatives of certain professions characterized by long stay on your feet, walking, carrying heavy objects, and so on. This category includes hairdressers and movers, 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. Marching foot can occur in 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 full recovery without complications.

In Deichlander's disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. Pathological reorganization of bone tissue in in this case due to changed mechanical and static-dynamic factors. The process most often involves the second metatarsal bone, less often the third, and even less often the fourth and fifth.

Usually one bone is affected, although it is possible for several bones in one or both feet to be affected simultaneously or sequentially. It has been established that marching foot is a special type of bone tissue transformation that is not associated with tumor or inflammation.

At the same time, the views of specialists on the nature of the damage are still divided. Some believe that bone remodeling is accompanied by an incomplete fracture or a so-called “microfracture.” Others believe that the term “marching fracture” should be considered outdated and not true, since only local resorption of bone tissue occurs, which is subsequently replaced by normal bone without the formation of a callus.

Causes of the problem

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

Whatever physical activity a person engages 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, 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 sports- this 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.

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.

Stress fractures can occur in athletes, dancers, heavy lifters, and other people whose bones are subject to excessive stress. Often a stress fracture occurs in people who are just starting sports activities, but incorrectly calculate the load. Their muscles and bones are not yet prepared as they should be, which is why various injuries legs, arms and back.

A crack in a bone can form not only due to severe overexertion. People suffering from osteoporosis are very susceptible to stress fractures. With this disease, the structure of a person’s bone changes, it becomes thin and brittle, so even a slight load can cause a stress fracture.

The reasons that provoke the occurrence of a march fracture include:

Low mobility in Everyday life followed by a heavy load;
Obesity, or vice versa, lack of weight due to poor nutrition or due to other problems in the body;
Diseases such as osteoporosis, osteomyelitis, bone tuberculosis, oncology;

Among athletes, a stress fracture is more often observed in football players, jumpers, runners, tennis players, gymnasts, weightlifters, and fitness trainers.

Going on a forced march, conscripts are not even aware of the load that awaits them. At home, few of them played sports, or, moreover, ran in the mornings. long distances. That is why those unaccustomed to

The bones of the feet cannot withstand heavy loads and break. Probably due to the fact that this type of injury is most often found among soldiers on forced marches, it was called marching.

For the same reason, there is a violation of the integrity of the bone in those who decide to go on a long hike for the first time. Without measuring your strength and sports training, many lovers of such walks quit the race precisely because of this type of injury.

March fracture of the cause

In addition to the military and athletes, representatives of the fair half of the planet’s population also face this problem. Lovers of high heels, like soldiers, are at risk. Moreover, they don’t even need to walk long distances to do this. Narrow shoes and high heels do their job - the bones of the feet, subject to constant compression and stress, become deformed and become brittle and brittle.

Another main risk group is athletes. By increasing the amount of loads and training before competitions, they can overdo it, which also leads to a metatarsus injury.

Even a small stone that gets under the foot while a person is walking or running can contribute to a marching fracture. Sometimes bones can also be damaged as a result of a fall or sprained foot. If, against the background of this, a fracture of one of the metatarsal bones has formed, then it will also have the name marching. The second, third and fourth fingers are most often injured. They are the thinnest and longest, and are most used when walking.

You can get such a fracture great amount people who lead an active lifestyle, are lovers of yoga, running, girls in high heels, etc.

The marching fracture got its name from the marching military. This category of citizens is most often found this pathology especially after active training or forced marches.

A marching fracture is a structural deformation of the metatarsal bone due to uneven loads on the foot.

Remove all factors that cause foot overload. That is, a rest mode is assigned to the foot. At first, you should try not to step on your sore leg.

The 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 fit the soldier's size. A sharp increase in loads on the feet also contributes to the onset of the disease. All of these factors are key.

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

Very often, a march fracture overtakes people on vacation. This is due to the fact that the overwhelming number of residents lead a passive lifestyle, and during the holidays they decide to change this, 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 occurs 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 separate group citizens whose professions are at risk. This is basically a job that requires people to be on their feet all day. This includes teachers, doctors, loaders, builders, etc.

Flat feet of various degrees;

Poorly purchased shoes that are uncomfortable to walk in;

Uneven loads on the foot.

With acute everything is clear. It begins to manifest itself some time after the overexertion has occurred, and the pain will be acute, subsiding over time.

Chronic, in turn, is characterized by the fact that the pain increases gradually and over time develops into unbearable painful sensations.

Whatever inconvenience this pathology may cause, it does not pose a danger, since there are practically no consequences from such an injury. In addition, recovery occurs relatively quickly.

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.

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.
Lovers of long walks wearing fashionable high-heeled shoes. In this case, the foot loses its shock-absorbing properties, and the maximum load falls on the thin metatarsal bones.
Representatives of professions who stand on their feet for a long time: sellers, hairdressers, tour guides, bartenders, waiters, etc.
Persons with osteoporosis (decreased bone density) - sometimes a slight load is enough to develop the marching foot.

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 is 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 are no characteristic symptoms, such as, heat or a change in the biochemical picture of the blood.

Average term The development of the disease takes several months, but it can pass much faster. Pain is present throughout the course of the disease.

Mechanism of development of the marching foot

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.

Symptoms of a march fracture

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.

In everyday life, a stress fracture may not show itself in any way other than minor pain, which people often attribute to simple fatigue legs The pain intensifies with physical activity and can be so severe that the victim has to take painkillers.

The following symptoms suggest the presence of a stress fracture:

The pain syndrome is wavy in nature. It becomes more pronounced during periods of human activity and subsides in a calm state.
When a microcrack occurs, the tissues of the limb swell greatly.
The site of injury is painful if a person feels it.
Sometimes small hematomas occur.

It is worth noting once again that these signs cannot give an absolute guarantee that a person has a march fracture, since they can be present in many other injuries, as well as diseases. For staging accurate diagnosis the victim must undergo a full examination.

Signs of a marching foot fracture

The main symptoms of a march fracture are pain and slight swelling over the broken bone. However, the X-ray will not show the characteristic fracture line of the metatarsal bones, since they break like a “green stick” - only the internal structures, and at the top there remains thin bone tissue connecting the edges of the broken bones.

The most popular way to diagnose a march fracture is palpation. If pressure on the bases of the metatarsal bones brings sharp pain, and also swelling of the soft tissues is clearly visible at the site of the supposed fracture, then the diagnosis is obvious - it is a marching foot. A fresh fracture can also be detected using magnetic resonance imaging. Through special regimes X-ray examination, the specialist notices a loss of bone tissue, which means that there is a gap in the metatarsal bones of the foot.

Treatment of a march fracture

Foot massage for a marching fracture

A fracture of the metatarsal bones of the foot does not require reduction, unlike many other bones human body. Therefore, to treat a march fracture, you do not need to wear an immobilizing cast, and the recovery period will take much less time. Although pressure on the forefoot should be limited, and immediately after recovery, the type of activity that caused the fatigue should be avoided for a while. bone fracture. Orthopedists recommend using special orthopedic insoles; they will relieve broken bones and make it easier to endure the disease.

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

We would like to offer you to watch a video about how you can massage the foot with a cruising fracture.

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

The main symptoms of a violation of the integrity of the metatarsal bone are pain in the foot area, tissue swelling, swelling, and pain when touched. If physical activity continues for some time after the fracture occurs, then deformation of the foot may occur. If, for example, an athlete, after the formation of a crack, continued to give increased load, then in this case even an injury may occur with displacement, blueness and bruising.

The main symptoms of a march fracture are pain in the area of pathology and almost imperceptible swelling of the defective bone.

Distinctive feature Such damage is that in the picture taken by X-ray, the fracture line will not be visible. This is explained by the fact that bone deformation occurs according to the “green twig” type.

During normal physical work or training, gradual hypertrophy of the loaded parts of the skeleton occurs, as is usually observed in physical workers, athletes or ballerinas. In the latter, hypertrophy of the predominantly loaded third metatarsal bones is especially noticeable. With excessive, unbearable load on the bones, exceeding normal reparative capabilities, restructuring processes develop.

If the etiological factor of the restructuring - mechanical overload of the bone - is proven, then the pathogenesis of the restructuring remains unclear. G.I. Turner, putting forward the neurotrophic theory, considered bone remodeling during marching fractures to be a secondary act, which is a consequence of primary irritation of the nerves under the influence of prolonged fatigue of the tense muscular and ligamentous apparatus.

A number of orthopedists believe that the primary factor in bone remodeling is the summation of microtraumas, which entails molecular shifts and even microfractures.

There are two clinical forms diseases: acute and primary chronic. The first is observed less frequently and develops 2-4 days after significant overexertion (for example, a long forced march). The second arises gradually, gradually. Its symptoms are less pronounced. There is no history of acute trauma to marching foot. Patients with this diagnosis complain of intense, sometimes unbearable pain in the midfoot.

Lameness appears, gait becomes uncertain, patients try to spare the injured limb. Upon examination, local swelling is detected over the middle part of the metatarsal bone and a denser swelling in the affected area. Skin sensitivity in this area increases. Hyperemia (redness of the skin) is observed quite rarely and is never pronounced.

Patients also never experience general symptoms: there is no increase in body temperature, no changes in the biochemical or morphological picture of the blood. The pain may persist for several weeks or even months. The average duration of the disease is 3-4 months. The disease ends with complete recovery.

Diagnostic methods

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 a 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.

The difficulty of diagnosing a march fracture is due to the fact that the fracture line is not visible on an x-ray, 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-ray shows 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.

The need for MRI arises if palpation causes severe pain, and slight inflammation is observed in the localized area.

The diagnosis is made based on a survey, examination and X-ray data. The picture obtained during the X-ray examination is of decisive importance.

With Deichlander's disease, a change in the structural pattern is detected in the area of the diaphysis of the affected metatarsal bone (sometimes closer to the head, sometimes to the base, depending on the location of the most functionally overloaded area). An oblique or transverse band of clearing (Looser's clearing zone) is determined - the area of bone restructuring.

Subsequently, periosteal growths appear around the affected part of the bone. At first they are thin and delicate, then dense, similar to a spindle-shaped callus. Later, the clearing zone disappears and sclerosis occurs.

Over time, the periosteal layers dissolve. In this case, the bone remains thickened and compacted forever. The defining features are the absence acute injury, typical localization of damage, as well as the presence of a zone of restructuring in the absence of displacement of fragments and preservation correct form bones.

Please note that during the first few days or weeks radiological signs diseases may be absent. Therefore, when characteristic symptoms Sometimes it is necessary to take several radiographs at a certain time interval.

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.

If you do X-ray examination In the first weeks after physical activity and the onset of pain, nothing may be detected. In a 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

Doctors do not offer any special treatment methods for a march fracture, since with any similar injury naturally callus appears, 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 to help relieve or properly distribute 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).

The march fracture is one of the most safe injuries of this kind, but should not be treated with disdain. Competent diagnostics and treatment will help you get rid of pain faster.

In case of a march fracture, treatment is carried out conservative method. A plaster cast is not applied for this injury, since there are no individual fragments or their displacement, however, the mobility of the broken limb should be limited. The patient is prescribed bed rest with the exception of physical activity. To relieve pain, you can apply cold to the place of the herb, but if the pain is very severe, then the doctor may prescribe painkillers or blockade with Novocaine injections.

Conservative treatment consists of the following steps:

Bed rest. The patient should rest as much as possible and move as little as possible. If you need to climb to the toilet, you should use a cane to avoid leaning heavily on the injured limb. To relieve swelling, the leg should be wrapped with an elastic bandage, but watch the color skin in order to notice circulatory problems in time.
Wearing orthopedic shoes or custom insoles. Insoles are preferable because they are made individually, taking into account all the features of a person’s foot and help distribute the load evenly over the entire foot. If there is a crack in the tibia, then shoes with a high back will securely fix the ankle, thereby protecting it from overstrain. Shoes and insoles should be worn from the moment the patient is allowed to stand up.
Immobilization. If the crack is very large, then it is necessary to apply a plaster cast, because the bone can break completely at any moment. In addition, when the severity of the injury is severe, the ligaments are often damaged, which is an indication for the application of a plaster cast.
Drug therapy. The patient is prescribed analgesics, drugs that relieve inflammation and accelerate bone tissue regeneration. Calcium intake is mandatory, and winter period and vitamin D. In summer, vitamin D is synthesized in the body under the influence of ultraviolet rays, therefore the patient is recommended to spend enough time outside in sunny weather, without loading the limb.
Physiotherapy. Starting from the third day of treatment, the patient must undergo physiotherapeutic procedures. Electrophoresis, magnetic therapy, paraffin applications accelerate the healing of the crack, activate metabolic processes, and stimulate blood circulation in the area of damage.

In rare cases, with very large and wide cracks, when there is a risk of complete fracture, the patient undergoes an operation during which a metal plate, which holds the crack together and prevents it from breaking.

There are three types of treatment for marching fractures.

Ensuring rest and complete absence of stress on the foot;
Complete immobilization of the foot (plaster cast or splint);
Operative surgery;

The first treatment option is used when the injury is classified as closed without displacement, that is, it is a mother-in-law.

If the doctor sees a displacement on the x-ray, or just a clearly defined fracture, then the lower limb must be immobilized and protected from accidental loads. For this, a plaster cast or splint is recommended.

Surgery is indicated when the fracture is displaced, which needs to be corrected, or when the injury has resulted in fragments of the metatarsal bone. Such cases are quite rare and are often traumatic in nature.

In fact, a march fracture is not as terrible as it might seem at first glance. The main thing to remember is one rule: if there is pain or swelling in the metatarsal area, you must contact a traumatologist. And in order to avoid complications of a march fracture, follow all his recommendations exactly.

Unlike other bone fractures, a sustainer fracture simply does not require any type of fixation. For its treatment there is no need to wear an immobilizing cast. The recovery period is quite fast. The only thing that needs to be done to speed up treatment is to limit the load on the damaged bones, and then full recovery you need to try to exclude for a long time the activity that caused the fracture.

At the request of the patient, the doctor may prescribe various kinds medications, ointments, creams, etc. against pain and inflammation.

Important. It is prohibited to use ultrasound and heat to treat such a fracture. Since these events interfere with the natural fusion of bones.

A person with such a disease is also prescribed static gymnastics. This type exercise helps to relax the calf muscles.

Prevention of marching fractures consists of proper training and wearing rationally constructed and well-fitting shoes.

Traumatologists treat marching foot. Treatment is strictly conservative, surgical interventions contraindicated. In the acute form, the patient is given a plaster splint and prescribed bed rest for 7-10 days. After the acute manifestations of the disease subside, as well as in the primary chronic form of the disease, massage and thermal (paraffin baths, baths) and other physiotherapeutic procedures are prescribed. Subsequently, patients are recommended to use insoles and avoid long walks.

Prevention consists of choosing comfortable shoes, choosing reasonable physical activity and careful medical monitoring of recruits.

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 unfavorable factor, which 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 are supplied to the body construction material, necessary for bone restoration.

Approach to therapy

For a stress fracture, conservative treatment is used. The goal of therapy is to relieve acute pain symptoms and eliminate the underlying mechanism that provoked the disease. Surgical intervention is never used in this case.

First of all, the patient is placed in a plaster cast on the foot and is prescribed bed rest, which should be at least a week. Man must be freed from long 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, Ibuprofen, Voltaren;
foot baths using sea salt or with herbal mixture;
physical therapy to relax the lower leg muscles, but the exercises should not involve the feet.

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

Possible 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 the pain may increase significantly.

The development of osteoporosis and a predisposition to a common fracture, even with minor trauma.

Osteoarthritis of the small joints of the 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!

Preventive actions

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

give up soon 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 you cannot go on a serious hiking trip that involves heavy loads without prior preparation. 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.

In order not to encounter a marching fracture, it is necessary to constantly monitor 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. You should give your muscles and bones rest and time to recover after exercise. During training, it is necessary to use high-quality and the right shoes, as well as elastic bandages.

Often, we ourselves are to blame for all our troubles. So it is with the march fracture. To minimize the risk of such an injury, it is recommended to avoid constantly wearing high heels, which deform the foot and do not allow the bones to form normally and, at least occasionally, to play sports. And walking on fresh air They will not only strengthen the bones of your legs, but will also have a beneficial effect on the health of the entire body.

Use only comfortable shoes;

If you have a passive lifestyle, try to avoid long periods of walking;

A marching fracture is one of the safest fractures in the human body. It has no serious consequences for the body, and it can be treated quickly enough. The most unpleasant thing about this pathology is pain in the foot area, which will accompany the person throughout the healing and fusion of the bones.

To avoid this, you need to follow some rules, lead an active lifestyle and be able to distribute the load on your foot.

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.

Oddly enough, people often get an injury called a “march fracture” while on vacation. Leading a passive, sedentary lifestyle almost all year round, when they go on vacation they decide to radically change something: 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.

The 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 fit the soldier's size.

A sharp increase in loads on the feet also contributes to the onset of the disease. All of these factors are key.

The picture will help you figure it out:

Very often, a march fracture overtakes people on vacation. This is due to the fact that the overwhelming number of residents lead a passive lifestyle, and during the holidays they decide to change this, 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 occurs 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. This is basically a job that requires people to be 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 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.

The main symptoms of a march fracture are pain in the area of pathology and 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 explained by the fact that bone deformation occurs according to the “green twig” type.

The main signs of marching foot are minor pain and swelling in the affected area. Made in acute period X-ray disease reflects the characteristic locations of fractures.

Damage to bones occurs according to the green stick principle - only deep bone tissues break, while the superficial ones remain unchanged. These signs can be seen in detail in the photo.

Photo. Closed fracture photo of the fifth metatarsal

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

Radiologically detectable changes in a march 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 clearing is found, enveloped in a fusiform thickening of ossified periosteum.

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 the healing of bone tissue, eliminating pain and discomfort) and physiotherapeutic procedures.

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.

Treatment

Treatment is conservative. It comes down to rest and unloading of the limb, immobilizing it for 3 - 4 weeks. plaster cast, the appointment of thermal physiotherapeutic procedures, massage and physical therapy.

The prognosis is favorable.

Prevention consists of strict medical supervision of recruits (treatment of flat feet), as well as wearing well-chosen, sensible shoes.

Prevention

In order to prevent the development of the disease, you should wear comfortable shoes with orthopedic insoles, and regularly undergo preventive examinations, promptly identify and treat functional impairment stop, avoid 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 poor nutrition, or with 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 properly and have good sleep. Experts also recommend the following:

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

Deutschlander's disease is diagnosed in people involved in athletics, serving in the army, welcoming various types of fitness and aerobics. The risk group also includes women who prefer high-heeled shoes.

A marching fracture of the foot is damage to the metatarsal bones that occurs during prolonged increased loads on your feet. Deutschlander's disease can also be found in people who wear incorrect shoes that put stress on the anterior section feet.

Accompanied by pronounced pain syndrome and swelling.

There is no specific treatment; a callus forms in the damaged part, and the fragments heal spontaneously. The main principle of therapy is to ensure reliable fixation of the affected area and limit any stress.

What causes Deutschlander's disease?

Conscripts are in the first place at risk. Military conditions, uncomfortable shoes and heavy physical activity all reduce the strength of vulnerable foot bones. From high blood pressure they may be damaged.

The second metatarsal bone is most susceptible to fractures, followed by the third and fourth. Injuries to the first and fifth are extremely rare. The disease owes its second name to soldiers who tirelessly march during their military service.

Tourists whose legs undergo excessive stress while traveling and on vacation may also be included in the risk group. Hiking, sightseeing and shopping are reasons why a stress fracture may occur. Heaviest loads test the feet of representatives of the fair half of humanity.

Symptoms of marching foot often appear in professional athletes. The reason for this is intensive training before competitions, changing the style of sneakers, difficult exercises, running long distances after a long rest.

hairdressers;
waiters;
medical workers;
tour guides.

In most cases, the provoking factor is flat feet or physical unpreparedness. Marching foot can take an acute or chronic course, affecting one or more metatarsal bones. However, the disease almost always has a favorable prognosis.

Symptoms

The main signs of marching foot are minor pain and swelling in the affected area. An x-ray taken during the acute period of the disease reflects the characteristic locations of fractures. Bone damage occurs - only deep bone tissues break, while the 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 the injury. A stress fracture is always closed.

How to determine the disease?

Diagnosis of Deutschlander syndrome is not particularly difficult. Most in a simple way identifying the marching foot is palpation. If pressing on the metatarsal bone results in severe pain, and there is obvious swelling in the affected area, we're talking about specifically about this disease.

Fresh fractures may be detected by MRI. Using special techniques, the radiologist notices a decrease in tissue density, which means that there are cracks in the metatarsal bone. Such fractures do not require reduction.

Methods of therapy

Fixing devices are not used to eliminate marching foot. The recovery period does not take much time. You can treat Deutschlander syndrome at home:

Doctors recommend limiting the load on the forefoot. After recovery, you will have to temporarily abandon the activity that triggered the onset of the disease.
Orthopedists advise wearing comfortable shoes equipped with special insoles. It reduces pressure on damaged bones and the intensity of pain.
Deutschlander syndrome is an indication for the use of pain-relieving creams and ointments, which are applied to clean skin of the feet 3-4 times a day.

Treatment of marching foot with ultrasound or heat is not allowed. These methods interfere with the process of bone healing. Useful in recovery period is a massage that can be performed at home.

The disease almost always ends in complete recovery; health-hazardous consequences occur extremely rarely. Six months after bone fusion, the patient can return to normal activities.

15.01.2015

Marching foot is a pathological change in the structure of the metatarsal bones that occurs as a result of excessive loads. It develops in soldiers, especially at the beginning of their service, as well as after intensive drill training, marches and cross-country races. In addition, this disease can occur in people whose profession requires constant standing, carrying heavy objects, or long walking.

Marching foot is a disease caused by pathological restructuring of the metatarsal bones due to excessive load. It is observed in soldiers, athletes and people whose profession involves long periods of walking, standing or carrying heavy objects. The likelihood of development increases with the use of uncomfortable shoes and flat feet. It can occur acutely or chronically, but more often it has a primary chronic course. It is treated conservatively and ends with complete recovery.

According to studies conducted in different countries, people with low level habitual physical activity. It is believed that this is due to lower bone strength. It is no coincidence that another category of such patients today is increasingly becoming tourists - office workers who, during their vacation, actively “run” around tourist attractions in uncomfortable shoes.

Mechanism of development of the marching foot

During the disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. The pathological reorganization of bone tissue in this case is due to changed mechanical and static-dynamic factors. The process most often involves the second metatarsal bone, less often the third, and even less often the fourth and fifth. This distribution is due to the characteristics of the load on the foot when standing and walking, since in such cases the inner and middle parts of the foot are “loaded” more. The first metatarsal bone is never affected. This is probably due to her more high density and strength.

Marching foot symptoms

There are two clinical forms of the disease: acute and primary chronic. The first is observed less frequently and develops 2-4 days after significant overexertion (for example, a long forced march). The second arises gradually, gradually. Its symptoms are less pronounced. There is no history of acute trauma to marching foot.

Patients with this diagnosis complain of intense, sometimes unbearable pain in the midfoot. Lameness appears, gait becomes uncertain, patients try to spare the injured limb. Upon examination, local swelling is detected over the middle part of the metatarsal bone and a denser swelling in the affected area. Skin sensitivity in this area increases. Hyperemia (redness of the skin) is observed quite rarely and is never pronounced. Patients also never experience general symptoms: there is no increase in body temperature, no changes in the biochemical or morphological picture of the blood.

The pain may persist for several weeks or even months. The average duration of the disease is 3-4 months. The disease ends with complete recovery.

Diagnosis of marching foot

The diagnosis is made based on a survey, examination and data radiography. The picture obtained during the X-ray examination is of decisive importance.

In case of disease in the area of the diaphysis of the affected metatarsal bone (sometimes closer to the head, sometimes to the base, depending on the location of the most functionally overloaded area), a change in the structural pattern is detected. An oblique or transverse band of clearing (Looser's clearing zone) is determined - the area of bone restructuring. It looks as if the metatarsal bone is divided into two fragments. However, unlike X-ray picture in case of a fracture, no displacement is observed in this case.

Subsequently, periosteal growths appear around the affected part of the bone. At first they are thin and tender, then dense, similar to a fusiform callus. Later, the clearing zone disappears and sclerosis occurs.

Over time, the periosteal layers dissolve. In this case, the bone remains thickened and compacted forever.

The defining features are the absence of acute injury, typical localization of damage, as well as the presence of a zone of restructuring in the absence of displacement of fragments and maintaining the correct shape of the bone.

It should be borne in mind that during the first few days or weeks there may be no radiological signs of the disease. Therefore, for characteristic symptoms, it is sometimes necessary to take several radiographs at a certain time interval.

Treatment and prevention of marching foot

Treatment is strictly conservative; surgical interventions are contraindicated. In the acute form, the patient is given a plaster splint and prescribed bed rest for 7-10 days. After the acute manifestations of the disease subside, as well as in the primary chronic form of the disease, massage and thermal (paraffin baths, baths) and other physiotherapeutic procedures are prescribed. Subsequently, patients are recommended to use insoles and avoid long walks.

Prevention consists of choosing comfortable shoes, choosing reasonable physical activity and careful medical monitoring of recruits.

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Start of activity (date): 01/15/2015 07:23:00
Created by (ID): 645
Keywords: foot, bone, pathological change