Topics:

Stress Fracture of the Base of the First Metatarsal Bone

Stress Fracture of the Base of the First Metatarsal Bone

ABSTRACT: A 29-year-old white man who is an avid runner presented with a 2½-year history of left midfoot pain on the dorsal area of the first metatarsal-cuneiform joint. Possible disorders included stress fracture of the base of the first metatarsal bone, Lisfranc ligament injury, extensor tendinopathy of the tibialis anterior tendon, synovitis of the metatarsal-cuneiform joint, and bone tumors. On the basis of the history and physical examination findings, stress fracture of the base of the first metatarsal bone was the diagnosis. The patient was placed in a foot and ankle brace for 6 to 8 weeks and received physiotherapy, forefoot strapping, and orthoses. The pain was alleviated significantly, and the patient resumed regular physical activity.

Leonardo da Vinci described the foot, an area of the lower extremities with a complex anatomy and biomechanics, as a “masterpiece of engineering.” However, forefoot injury often results from acute trauma or chronic overuse in athletes who participate in high-impact sports that involve running and jumping. The most common causes of forefoot pain in athletes are metatarsal stress fracture, sesamoid pathology, metatarsalgia, hallux valgus, and turf toe. A detailed history is vital in making a differential diagnosis and a diagnosis supported by investigations to provide a structured treatment plan.1,2

In this article, we present a rare case of stress fracture of the base of the first metatarsal bone in a young runner. The goal is to illustrate the importance of the history and investigations in the management of foot pain in athletes.

Presenting Complaint

A 29-year-old white man who is a writer and an avid runner presented to the clinic with a 2½-year history of left midfoot pain on the dorsal area of the first metatarsal-cuneiform joint. The main area of pain appeared to be over the medial dorsal area of the forefoot, around the base of the first metatarsal bone. There was some radiating pain over the first metatarsophalangeal (MTP) joint.

The patient described the pain as sharp and throbbing with variable intensity. It was rated between 0/10 and 8/10 on the Numeric Pain Scale. The pain sometimes disturbed sleep and caused the patient to have difficulty in going to sleep, although that varied with the patient’s activity level during the day. It was induced and increased with weight-bearing activities while the patient walked, ran, and jumped. He experienced some pain relief with rest, and the duration was variable. He sometimes felt numbness around the medial dorsal surface of the midfoot and forefoot.

History of Present Complaint

The pain originally occurred while the patient was running on a treadmill 2½ years earlier. There was no obvious history of acute trauma or injury to the left foot. The pain had a gradual onset and worsened with continued running. The patient felt a severe, sharp, shooting pain. At first, it was not localized, but it worsened after about 5 minutes of walking. After a variable period of rest, the pain would decrease in intensity but became a more diffused, dull, aching pain over the whole medial dorsal surface of the left foot.

There was no bruising, swelling, skin discoloration, skin lesion, temperature change, or obvious deformity, although the patient felt stiffness in his midfoot joints, with some limitation in the first MTP joint. He denied any previous injury to the left foot. The findings were largely unremarkable, with no significant history of musculoskeletal disease.

The patient kept fit by playing tennis on a regular basis and running about 10 to 15 miles per week, primarily on a treadmill but also on roads and cross-country. He stopped all his physical activity because of limitations imposed by his left foot pain.

The patient currently was using over-the-counter NSAIDs, which helped marginally. He received an injection of corticosteroids and anesthetic in the painful area, but there was no result. He has no drug allergy. He reported feeling well and fit.

Possible disorders in the differential diagnosis include the following:

• Stress fracture of the base of the first metatarsal bone

• Lisfranc ligament injury

• Extensor tendinopathy of the tibialis anterior tendon

• Synovitis of the metatarsal-cuneiform joint

• Bone tumors

Pages

 
Loading comments...
Please Wait 20 seconds or click here to close