OVERUSE BALLET INJURY OF THE BASE OF THE 2ND METATARSAL - A DIAGNOSTIC PROBLEM

Performing classical ballet may cause major stress to the feet of the dancer. A variety of foot injuries have been described, with one such injury being an overuse syndrome involving the base of the second meta tarsal and adjacent Lisfranc's joint. The diagnosis for this syndrome usually requires differentiating synovitis of Lisfranc's joint from a stress reaction of the base of the second metatarsal. Prompt diagnosis is important since the treatment for these two conditions differs sig nificantly and, in the case of bone stress reaction, delay can cause p rogression of the lesion. We report good clinical results in a group o f eight ballerinas for whom we obtained early diagnosis and treatment of their injuries. This is in contrast to poor results reported in the literature if the diagnosis and management of these types of injuries are delayed. We developed a simple diagnostic protocol to enable diag nosis at presentation. When a bone stress reaction had progressed to a fracture line, a characteristic appearance was found on magnetic reso nance imaging, suggesting a specific mechanism of injury. A possible m echanism for this injury is discussed.