Fourth Metatarsal Research Articles

March fractures of the foot: Care and management of 692 patients

1. 1. Six hundred and ninety two cases are reported with 724 march fractures. 2. 2. These patients were all treated by use of the steel bar countersunk in the slip sole of the shoe. 3. 3. Fifty-eight cases did not respond to the usual treatment; of this number thirteen were hospitalized and forty-five excused from certain portions of their training cycle. These fifty-eight trainees eventually finished training and were qualified for overseas. One man received a medical discharge. This was for an injured right knee and not for his march fracture. 4. 4. Two hundred thirteen thousand and twenty-four training hours were saved during fourteen months using the march bar treatment. 5. 5. Our series shows that most of the fractures occurred when the training cycle was stepped up in the fifth and sixth weeks of training. 6. 6. March fracture occurred more often in the right foot than the left. Any one of the metatarsal bones may be involved and one soldier can have two or three march fractures at the same time. 7. 7. The relative lengths of the first, third, and fourth metatarsal bones were measured in 692 cases of march fracture; the second metatarsal being used as a base and given the value of zero. The metatarsals of 100 normal feet were measured, and these measurements compared with the march fractured feet. There was no conclusive evidence of a relatively shortened first metatarsal playing a part in the etiological factor of march fractures.

Os Intermetatarseum: Unusual Variant

Os intermetatarseum is described as an accessory bone of rather rare occurrence (1, 2, 5). Almost all of the cases thus far recorded have been rather diminutive osseous bodies lying usually between the bases of the first and second metatarsals. Sometimes the bone appears as spindle-shaped, projecting a half or a third of the distance to the heads of the other metatarsals. One well known authority writes in a recent text (5): “The os intermetatarseum is a small accessory bone lying between the bases of the first and second metatarsal bones; it is sometimes attached to the second metatarsal bone and projects in such a way as to suggest the appearance of a rudimentary metatarsal bone. It is seen only rarely and does not give rise to symptoms.” A search of the literature tends to confirm this observation as to symptoms, though in one case occurring at the New York Orthopaedic Dispensary and Hospital, such a bone occurring between the first and second metatarsals was considered to play an etiologic röle in the production of a hallux valgus (6). The case here presented is of interest because of the unusual situation of an os intermetatarseum; it appears in the space between the fourth and fifth metatarsals, articulates distally with the phalanx, the “true” fourth metatarsal head appearing to be distinctly extra-articular, and tapers to a small proximal end, which appears free. The “true” fourth metatarsal articulates with the tarsus at its base. It would appear that the “true” fourth metatarsal lies below, the accessory metatarsal above. A further anomaly is present in that the fourth toe appears to have only two phalanges. On physical examination the foot appeared to show some increase in thickness in the region of the fourth metatarsal. The fourth toe was shorter than the corresponding toe on the opposite foot. A callus was present over the fourth metatarsal head region on the plantar surface of the foot. The patient, who was a woman fifty years of age and who had been sent for examination to rule out fracture in a case of sprained ankle, gave only an ambiguous history of any previous symptoms referable to the foot. She was questioned further because of an incidental finding of Freiberg's disease (deforming metatarsophalangeal osteochondritis) in the second metatarsal head. If there had ever been an acute phase in the latter condition, the history gave little clue to it. Relative to Freiberg's disease, Hauser (5) makes the comment: “The condition is believed to be the result of mechanical strain and abnormal repeated traumas that occur at the heads of the second and third metatarsal bones. It is usually seen in cases of pes valgoplanus associated with metatarsus latus. “Since the second metatarsal bone is generally the longest, it is exposed to increased weight bearing and trauma.”

March Foot or Pied Force

MARCH foot, as the name implies, was first noticed in soldiers on the march, particularly those carrying heavy packs. It was originally described in 1855, by Breithaupt, who called it “Fussgeschwulst.” Many European and English writers have discussed the subject since, but only scattered reports of it can be found in American literature. Even before the advent of the x-ray, the condition was recognized as a fracture, but it was not until 1921 that Deutschlander noted the condition in civilians and reported six cases, all of them in women. March foot is persistently edematous and painful, beginning rather insignificantly with soreness, and progressing in severity until the pain becomes intense enough to incapacitate the individual. It is usually accompanied by a spontaneous fracture of the second, third, or fourth metatarsal bone just proximal to the head. The pain and swelling are localized over the dorsum of the foot and centered over the shaft of the involved bone. The swelling pits very slightly on pre...

TWENTY-SEVENTH REPORT OF PROGRESS IN ORTHOPEDIC SURGERY

HEREDITARY AND DEVELOPMENTAL DEFORMITIES Chondrodystrophy with Flattening of the Vertebrae. —Guerin and Lachapele 1 report a case of chondrodystrophy, the patient being a boy aged 7 . They label the condition in this case platybrachyspondylie, since the vertebrae, particularly in the lower portion of the dorsal region, were large and flat, each tending to end anteriorly in a pointed extremity. This resulted in moderate dorsal.kyphosis. Associated abnormalities of the skeleton in other regions were also found. In both feet there was a tendency to hallux valgus. The first metatarsal bone was large and short, with a large epiphysis. The second, third and fourth metatarsal bones were curved medially. In place of the scaphoid and the first cuneiform bone there were several ill defined centers of ossification and the second and the third cuneiform bone were fused. Both hips exhibited coxa vara deformity. There was general retardation in the development of most

The Second and Fourth Digits in the Horse: their Development and Subsequent Degeneration

During the last fifty years not a few familiar and apparently quite uninteresting structures have all at once assumed unusual importance and arrested the attention of naturalists in all parts of the world. This is especially true of what used to be known as rudiments, of what we nowadays generally designate vestiges. Of all the known vestiges, the most familiar are perhaps the “splint” bones of the horse. For long the interest in these splints was extremely limited, but since it was shown that they correspond to the functional second and fourth metacarpals and metatarsals of other vertebrates they have attracted the notice of both comparative anatomists and palæozoologists, and are now invariably looked upon as affording strong evidence in support of the view that the horse has descended from polydaetylous ancestors.