STRESS-FRACTURES AT THE BASE OF THE 2ND METATARSAL IN BALLET DANCERS

Stress fractures are a frequent injury in ballet companies and the mos t common location is at the base of the second metatarsal, While previ ous reports have focused on risk factors for this injury (overtraining , delayed menarche, poor nutrition), there is no published series desc ribing the natural history and outcome following this fracture, We rev iewed the office records of the senior author and identified 51 profes sional dancers (64 fractures) who sustained a stress fracture at the b ase of the second metatarsal. History of a previous stress fracture in the lower extremity was seen in 19 patients and delayed menarche in t he women was common, The clinical presentation was insidious onset of midfoot pain an average of 2.5 weeks prior to seeking medical care, Th e initial radiographs of the foot were positive in 19 patients, questi onable in 3 patients, and negative in 42 patients, The usual location of the fracture was at the proximal metaphyseal-diaphyseal junction (t hree fractures extended into the tarsometatarsal joint), Treatment con sisted of a short leg walking cast for 6 patients, and a wooden shoe a nd symptomatic treatment for the remainder, At follow-up, 14% of patie nts still had occasional pain or stiffness in the midfoot with dancing , The patients returned to performance at an average of 6.2 weeks foll owing diagnosis, No patients required bone grafting for persistent sym ptoms, There were eight refractures (at the same site) occurring an av erage of 4.3 years, all of which healed with conservative care, Stress fractures at the base of the second metatarsal are common in ballet d ancers and can usually be treated with symptomatically. The results of this study are discussed in terms of risk factors, the use of a poste rior-anterior view of the foot to eliminate overlap at Lisfranc's join t, and our present treatment regimen.