Skip to main content

Stress Fractures of the Foot and Ankle in Athletes

  • Chapter
  • First Online:
Sports Medicine and Arthroscopic Surgery of the Foot and Ankle

Abstract

Stress fractures of the foot and ankle can be a source of significant disability and rapid deconditioning of the high-performance athlete, resulting in lost time in competitive play and training. Additionally, complications such as nonunions or delayed unions prolong the time for healing and can be a career-altering event. Certain anatomical regions in the foot and ankle are prone to fracture, delayed union and nonunion, along with re-fracture. Due to the high-demand of athletic and active patients, surgery is often recommended for specific injuries. The most well-known and notorious injuries involved are “Jones” fractures, proximal fifth metatarsal stress fractures, Navicular stress fractures; less common but equally debilating are medial malleolar stress fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Petrisor BA, Ekrol I, Court-Brown C. The epidemiology of metatarsal fractures. Foot Ankle Int. 2006;27(3):172–4.

    PubMed  Google Scholar 

  2. Niva MH, Sormaala MJ, Kiuru MJ, et al. Bone stress injuries of the ankle and foot: an 86-month magnetic resonance imaging-based study of physically active young adults. Am J Sports Med. 2007;35(4):643–9.

    Article  PubMed  Google Scholar 

  3. Sarrafian S. Anatomy of the foot and ankle. Philadelphia: Lippincott; 1993.

    Google Scholar 

  4. Carp L. Fracture of the fifth metatarsal bone: with special reference to delayed union. Ann Surg. 1927;86(2):308–20.

    Article  PubMed  CAS  Google Scholar 

  5. Quill GE Jr. Fractures of the proximal fifth metatarsal. Orthop Clin North Am. 1995;26(2):353–61.

    PubMed  Google Scholar 

  6. Kavanaugh JH, Brower TD, Mann RV. The Jones fracture revisited. J Bone Joint Surg Am. 1978;60(6):776–82.

    PubMed  CAS  Google Scholar 

  7. DeLee JC, Evans JP, Julian J. Stress fracture of the fifth metatarsal. Am J Sports Med. 1983;11(5):349–53.

    Article  PubMed  CAS  Google Scholar 

  8. Clapper MF, O’Brien TJ, Lyons PM. Fractures of the fifth metatarsal. Analysis of a fracture registry. Clin Orthop Relat Res. 1995;315:238–41.

    PubMed  Google Scholar 

  9. Smith JW, Arnoczky SP, Hersh A. The intraosseous blood supply of the fifth metatarsal: implications for proximal fracture healing. Foot Ankle. 1992;13(3):143–52.

    PubMed  CAS  Google Scholar 

  10. Shereff MJ, Yang QM, Kummer FJ, et al. Vascular anatomy of the fifth metatarsal. Foot Ankle. 1991;11(6):350–3.

    PubMed  CAS  Google Scholar 

  11. Torg JS, Balduini FC, Zelko RR, et al. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66(2):209–14.

    PubMed  CAS  Google Scholar 

  12. Dameron TB Jr. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. J Bone Joint Surg Am. 1975;57(6):788–92.

    PubMed  Google Scholar 

  13. Stewart IM. Jones’s fracture: fracture of base of fifth metatarsal. Clin Orthop. 1960;16:190–8.

    PubMed  CAS  Google Scholar 

  14. Rosenberg GA, Sferra JJ. Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal. J Am Acad Orthop Surg. 2000;8(5):332–8.

    PubMed  CAS  Google Scholar 

  15. Jones R. Fractures of the base of the 5th metatarsal bone. Ann Surg. 1902;35:697–702.

    PubMed  CAS  Google Scholar 

  16. Zelko RR, Torg JS, Rachun A. Proximal diaphyseal fractures of the fifth metatarsal—treatment of the fractures and their complications in athletes. Am J Sports Med. 1979;7(2):95–101.

    Article  PubMed  CAS  Google Scholar 

  17. Donahue SW, Sharkey NA, Modanlou KA, et al. Bone strain and microcracks at stress fracture sites in human metatarsals. Bone. 2000;27(6):827–33.

    Article  PubMed  CAS  Google Scholar 

  18. Chuckpaiwong B, Queen RM, Easley ME, et al. Distinguishing Jones and proximal diaphyseal fractures of the fifth metatarsal. Clin Orthop Relat Res. 2008;466(8):1966–70.

    Article  PubMed  Google Scholar 

  19. Porter DA, Duncan M, Meyer SJ. Fifth metatarsal Jones fracture fixation with a 4.5-mm cannulated stainless steel screw in the competitive and recreational athlete: a clinical and radiographic evaluation. Am J Sports Med. 2005;33(5):726–33.

    Article  PubMed  Google Scholar 

  20. Dameron TB Jr. Fractures of the proximal fifth metatarsal: selecting the best treatment option. J Am Acad Orthop Surg. 1995;3(2):110–4.

    PubMed  Google Scholar 

  21. Landorf KB. Clarifying proximal diaphyseal fifth metatarsal fractures. The acute fracture versus the stress fracture. J Am Podiatr Med Assoc. 1999;89(8):398–404.

    PubMed  CAS  Google Scholar 

  22. Roca J, Roure F, Fernandez Fairen M, et al. Stress fractures of the fifth metatarsal. Acta Orthop Belg. 1980;46(5):630–6.

    PubMed  CAS  Google Scholar 

  23. Den Hartog BD. Fracture of the proximal fifth metatarsal. J Am Acad Orthop Surg. 2009;17(7):458–64.

    Google Scholar 

  24. Johnson JT, Labib SA, Fowler R. Intramedullary screw fixation of the fifth metatarsal: an anatomic study and improved technique. Foot Ankle Int. 2004;25(4):274–7.

    PubMed  Google Scholar 

  25. Pietropaoli MP, Wnorowski DC, Werner FW, et al. Intramedullary screw fixation of Jones fractures: a biomechanical study. Foot Ankle Int. 1999;20(9):560–3.

    PubMed  CAS  Google Scholar 

  26. Sides SD, Fetter NL, Glisson R, et al. Bending stiffness and pull-out strength of tapered, variable pitch screws, and 6.5-mm cancellous screws in acute Jones fractures. Foot Ankle Int. 2006;27(10):821–5.

    PubMed  Google Scholar 

  27. Nunley JA, Glisson RR. A new option for intramedullary fixation of Jones fractures: the Charlotte Carolina Jones fracture system. Foot Ankle Int. 2008;29(12):1216–21.

    Article  PubMed  Google Scholar 

  28. Glasgow MT, Naranja RJ Jr, Glasgow SG, et al. Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture. Foot Ankle Int. 1996;17(8):449–57.

    PubMed  CAS  Google Scholar 

  29. Larson CM, Almekinders LC, Taft TN, et al. Intramedullary screw fixation of Jones fractures. Analysis of failure. Am J Sports Med. 2002;30(1):55–60.

    PubMed  Google Scholar 

  30. Wright RW, Fischer DA, Shively RA, et al. Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes. Am J Sports Med. 2000;28(5):732–6.

    PubMed  CAS  Google Scholar 

  31. Towne LC, Blazina ME, Cozen LN. Fatigue fracture of the tarsal navicular. J Bone Joint Surg Am. 1970;52:376–8.

    PubMed  CAS  Google Scholar 

  32. Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med. 1996;6(2):85–9.

    Article  PubMed  CAS  Google Scholar 

  33. Torg JS, Pavlov H, Cooley LH, et al. Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases. J Bone Joint Surg Am. 1982;64:700–12.

    PubMed  CAS  Google Scholar 

  34. Saxena A, Fullem B, Hannaford D. Results of treatment of 22 navicular stress fractures and a new proposed ­radiographic classification system. J Foot Ankle Surg. 2000;39:96–103.

    Article  PubMed  CAS  Google Scholar 

  35. Fitch KD, Blackwell JB, Gilmour WN. Operation for non-union of stress fracture of the tarsal navicular. J Bone Joint Surg Br. 1989;71:105–10.

    PubMed  CAS  Google Scholar 

  36. Khan KM, Brukner PD, Kearney C, Fuller PJ, Bradshaw CJ, Kiss ZS. Tarsal navicular stress fracture in athletes. Sports Med. 1994;17:65–76.

    Article  PubMed  CAS  Google Scholar 

  37. Saxena A, Fullem B. Navicular stress fractures: a prospective study on athletes. Foot Ankle Int. 2006;27(11):917–21.

    PubMed  Google Scholar 

  38. Mann J, Pedowitz D. Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery and persistent pain after treatment. Foot Ankle Clin. 2009;14:187–204.

    Article  PubMed  Google Scholar 

  39. Potter NJ, Brukner PD, Makdissi M, Crossley K, Kiss ZS, Bradshaw C. Navicular stress fractures: outcomes of surgical and conservative management. Br J Sports Med. 2006;40(8):692–5.

    Article  PubMed  CAS  Google Scholar 

  40. Burne SG, Mahoney CM, Forster BB, Koehle MS, Taunton JE, Khan KM. Tarsal navicular stress injury: long-term ­outcome and clinicoradiological correlation using both ­computed tomography and magnetic resonance imaging. Am J Sports Med. 2005;33(12):1875–81.

    Article  PubMed  Google Scholar 

  41. Kaeding CC, Yu JR, Wright R, Amendola A, Spindler KP. Management and return to play of stress fractures. Clin J Sport Med. 2005;15(6):442–7.

    Article  PubMed  Google Scholar 

  42. Sherbondy PS, Sebastianelli WJ. Stress fractures of the medial malleolus and distal fibula. Clin Sports Med. 2006;25(1):129–37.

    Article  PubMed  Google Scholar 

  43. Kor A, Saltzman AT, Wempe PD. Medial malleolar stress fractures. Literature review, diagnosis, and treatment. J Am Podiatr Med Assoc. 2003;93(4):292–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amol Saxena D.P.M. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Saxena, A., Liu, G.T., Fullem, B.W., Allen, M.A. (2013). Stress Fractures of the Foot and Ankle in Athletes. In: Saxena, A. (eds) Sports Medicine and Arthroscopic Surgery of the Foot and Ankle. Springer, London. https://doi.org/10.1007/978-1-4471-4106-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4106-8_6

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4105-1

  • Online ISBN: 978-1-4471-4106-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics