title: Stress fractures of the lateral metatarsal bones in metatarsus adductus foot deformity: a previously unrecognized association.
abstract: OBJECTIVE
  To document a distinctive pattern of stress fractures in the lateral metatarsal bones of patients with metatarsus adductus foot deformity.
  
  
  METHODS
  Conventional radiographs and available medical records were reviewed in 11 patients (6 women, 5 men; ages 25-61 years) with stress fractures of the lateral (fourth or fifth) metatarsal bones and metatarsus adductus. Evaluation included the number and location of fracture(s), forefoot adduction angle, and qualitative assessment of bone mineral density. Conditions that might predispose patients to metatarsal fractures, including direct trauma, osteoporosis, and neuropathic osteoarthropathy were also recorded.
  
  
  RESULTS
  A total of 22 stress fractures were demonstrated, 17 of which involved the lateral metatarsals. A solitary fracture was present in six patients, while multiple fractures were evident in five patients. The sites of involvement were the fifth metatarsal (n=10), fourth metatarsal (n=7), third metatarsal (n=3), second metatarsal (n=1), and first metatarsal (n=1) bones. The locations of the stress fractures were in the proximal one-third of the metatarsal bones in 19 instances (86%) and in the middle one-third in three instances (14%). Forefoot adduction angle measured between 21 degrees and 37 degrees (normal range 8 degrees -14 degrees).
  
  
  CONCLUSIONS
  Patients with metatarsus adductus may be at increased risk for stress fractures involving the lateral metatarsal bones, likely owing to the presence of altered biomechanics that place greater loads across the lateral aspect of the foot.
authors.affiliation: Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, San Diego 92161, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Theodorou
authors.forename: S J
authors.initials: SJ
authors.lastname: Theodorou
authors.forename: R D
authors.initials: RD
authors.lastname: Boutin
authors.forename: C
authors.initials: C
authors.lastname: Chung
authors.forename: E
authors.initials: E
authors.lastname: Fliszar
authors.forename: Y
authors.initials: Y
authors.lastname: Kakitsubata
authors.forename: D
authors.initials: D
authors.lastname: Resnick
mesh_terms: D000328:Adult; D005260:Female; D005531:Foot Deformities, Acquired / Q000150:complications* / Q000000981:diagnostic imaging; D015775:Fractures, Stress / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011859:Radiography