Recurrent metatarsal stress fractures in a college football lineman.
Stress fractures are common overuse injuries of bone attributed to repetitive trauma, training errors, and/or structural abnormalities. A 21-year-old, 252-lb football lineman participating in spring conditioning drills complained of right foot pain following a plantar flexion, inversion injury that occurred while cutting. Pain was concentrated over the dorsum of the foot in both weight bearing and at rest. X-ray evaluation indicated an acute stress fracture of the fourth metatarsal and two nonunions of the second and third metatarsals. Additionally, x-rays revealed metatarsus adductus, a congenital anatomic deformity. The athlete demonstrated compensatory hyperpronation in the right hind foot during a follow-up biomechanical evaluation. He was removed from weightbearing activities, treated symptomatically for pain and swelling, and placed in a rigid orthotic. He has returned to full activity without further incident. This case report emphasizes the important role that biomechanical factors may have in osseous stress injuries.
Jamie L. Moul is Athletic Training Curriculum Director at Appalachian State University, Boone, NC 28606.
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