title: Stress fracture of the first metatarsal after total knee arthroplasty: two case reports using gait analysis.
abstract: Stress fractures after total knee arthroplasty (TKA) occur mainly in patients with considerable deformity of the knee. In addition, the majority of these fractures after TKA involve the hip joint. We present two cases of stress fractures of the first metatarsal after TKA in patients with severe varus deformity. Correction of leg alignment and pain reduction obtained by TKA lead to stress fracture of the bone. Gait analysis was carried out for both cases in order to clarify the gait characteristics of the stress fracture. As a result, side-to-side differences of the distance between first metatarsal and foot center of pressure in the coronal plane were observed using gait analysis in these patients. Fortunately, conservative treatment was successful for these patients. Stress fractures should be considered when a patient who had a considerable severe deformity of the knee preoperatively complains of foot pain on the affected side. Contrary to stress fractures at the hip joint, patients with the fracture of the first metatarsal can be treated without surgery.
authors.affiliation: Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kanagawa Prefecture, Japan; Department of Orthopedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. Electronic address: kharatoh@yahoo.co.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Harato
authors.affiliation: Department of Orthopedic Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ozaki
authors.affiliation: Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Sakurai
authors.affiliation: Department of Physical Therapy, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Otani
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015519:Bone Density; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005684:Gait; D006801:Humans; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D011859:Radiography; D012146:Rest; D012598:Sclerosis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal