March fracture of the metatarsal bone. Deutschlander's disease (marching fracture, marching foot) Marching fracture of the metatarsal bone treatment

Deutschlander's disease is damage to the bones of the metatarsus. The pathology is named after the doctor who described this disease in 1921. The disease occurs due to increased stress on the legs. It is characterized by changes in bone structure. Identifying such a disease can sometimes be quite difficult. Sometimes even experts mistakenly diagnose this disease as osteomyelitis or bone tumor. This pathology is otherwise called marching foot, as it often occurs in young soldiers after long forced marches.

Pathogenesis

The metatarsus is the middle part of the foot. It is located between the tarsal bone and the fingers. This section of the lower limb consists of five bones and experiences the greatest load when standing and walking.

With Deutschlander's disease, restructuring and partial resorption of bone tissue occurs. The second and third metatarsal bones are usually affected, as they bear the heaviest load. On an x-ray, the changes appear as if one part of the bone has partially separated from another. Therefore, the disease is often called a march fracture.

However, this pathology does not arise as a result of trauma. It does not completely tear off the bone. This disease is only superficially similar to an incomplete fracture. Over time, the affected areas are covered with normal bone tissue. Therefore, many experts consider the term march fracture obsolete.

X-ray changes in this pathology can be seen in the photo below.

Risk group

The disease most often develops in patients with flat feet. Also at risk are people whose activities involve increased stress on their legs:

• recruit soldiers;
• tourists;
• athletes;
• dancers;
• tour guides;
• waiters;
• hairdressers.

Wearing uncomfortable shoes can provoke Deutschlander's disease. Pathological changes in the metatarsal bones are often observed in women wearing high-heeled shoes.

This disease often develops in untrained people. In a person who is not accustomed to intense physical activity, pathology can occur even after systematic long walks.

Symptoms

The acute form of the disease develops 3-4 days after heavy load on the legs (for example, a long hike or forced march). The patient has pain in the foot and swelling above the metatarsal bones. The discomfort can be quite intense.

The primary chronic form of the disease is more common. Symptoms of bone damage increase gradually. At first, the pain is mild and does not interfere with movement. The patient often wonders why his foot hurts, because he has not had any injuries.

Over time, the pain becomes intense and unbearable. The patient begins to limp severely. A person tries to step on the injured limb as little as possible due to pain in the foot. The swelling on top of the metatarsus looks like a dense edema. There is pain when pressing on it.

Very rarely, slight redness of the skin is observed in the area of ​​edema. At the same time, the patient’s general well-being is not impaired, there is no high temperature or weakness.

Such symptoms may bother the patient for 3-4 months. Then the pain subsides, and the pathology ends with recovery. The changed areas of the metatarsus are covered with normal bone tissue. We can say that this disease always ends on its own and does not cause complications. However, you should not neglect therapy. The pain associated with this pathology can be very severe. Often the patient cannot move normally due to discomfort.

Diagnostics

This pathology is treated by a traumatologist or orthopedist. The most reliable diagnostic method is an x-ray of the foot. The following changes can be seen in the image:

1. At the onset of the disease, changes in the structure of bone tissue are visible. You may notice an oblique or transverse light stripe. It is in this area that pathological bone restructuring occurs. This looks a lot like a fracture. The bone seems to be divided into two parts. However, unlike a true fracture, there is no tissue displacement.
2. Subsequently, growths appear around the site of the lesion, and then a bone callus forms. The light stripe gradually disappears.
3. During the recovery stage, the callus resolves. However, the bone remains thickened.

Taking an anamnesis plays an important role in diagnosing the disease. It is necessary to establish that the patient has not had any previous injuries to the extremities.

X-ray signs of bone tissue damage may be absent in the first days and even weeks of illness. Therefore, it is recommended to repeat the examination several times.

Treatment methods

Unlike a real fracture, Deutschlander's disease does not require a cast. However, it is necessary to temporarily limit the load on the legs.

For severe pain, analgesic ointments and gels are prescribed:

• "Troxevasin";
• "Gevkamen";
• "Efkamon";
• "Bom-benge";
• "Boromenthol".

After removing the splint bandage, the patient is prescribed a course of physiotherapy. Massage, warm foot baths, and paraffin applications on the metatarsal area are indicated. In the future, patients are advised to use shoe insoles and avoid excessive stress on the lower extremities.

Prevention

We can conclude that this disease is easily curable and does not cause complications. However, it significantly reduces the patient's quality of life. Therefore, it is necessary to take measures to prevent pathology.

If a person’s activity involves stress on the legs, then it is necessary to periodically undergo a course of therapeutic massage. At home, it is useful to do foot baths after a working day. For long walks, you should wear comfortable low-heeled shoes. Newly recruited soldiers should be examined regularly by an orthopedic surgeon. This will help avoid damage to the metatarsal bones.

A march fracture is a stress fracture of the tarsal bones. This pathology occurs as a result of excessive and prolonged walking. The disease often occurs in soldiers and military personnel after a forced march. The pathology is also typical for athletes who expose themselves to excessive physical activity.

A marching fracture of the metatarsal bone often occurs due to uncomfortable shoes and overexertion during physical exercise. The main cause of the pathology is the occurrence of one or more cracks in the thickened part of the metatarsal bone.

A stress fracture often forms in the bones of the lower leg or tibia. Under different conditions, there is a discrepancy between the tension of the muscles of the lower extremities and the loads. The disease often manifests itself with repeated exercise.

Mechanism of development of the marching foot

Marching foot fracture is also called Deichlander's disease. Pathological changes occur in the middle part of the metatarsal bone. Bone tissue begins to restructure as a result of mechanical and static-dynamic factors.

In most cases, cracks occur in only one bone. There is a possibility of simultaneous or sequential damage to several bones. With marching foot, pathological transformation of bone tissue occurs. This process is not associated with inflammation or tumor.

Who is at risk

Marching fractures of the foot or leg occur in people of different professions. The occurrence of this disease is influenced by various factors. The risk group includes:

1. Young conscripts. A person finds himself in special conditions that may require wearing uncomfortable shoes. Recruits have to deal with extreme physical stress. These factors contribute to the formation of single or multiple cracks on thin bones.
2. Professional tourists and outdoor enthusiasts. In this case, the person faces a fatigue fracture. He has to walk for a long time on rough mountain-type terrain. The legs bear the entire load - body weight, backpack and additional equipment.
3. Athletes. When a person prepares for a competition, he loads himself with grueling training. As a result, there is a high risk of injury.
4. People who have to spend most of their time on their feet. These could be hairdressers, sellers, loaders, medical workers, couriers.

Pathology occurs as a result of functional overload of the foot. It is not associated with inflammation or cancer.

Symptoms and stages

Many people want to know what the sensations and signs of a march fracture are. When cracks occur, severe pain occurs. There are several stages of pathology development.

Acute

An acute marching bone fracture is manifested by acute pain. There is severe overexertion and slight swelling. The feeling of pain is constant and begins to gradually subside 2-3 days after the injury.

Subacute

With a subacute marching bone fracture, the pain regularly increases and subsides. The person experiences periods of relief and severe pain.

Chronic

The pain begins to increase gradually. After a while, the person cannot walk independently because acute pain occurs. The foot becomes very swollen, making it difficult to wear shoes.

A dense swelling appears in the affected area. The skin becomes more sensitive. Changes in skin tone are rare.

First aid

When you receive a bone fracture, you must place your foot on a hard surface and ensure complete rest for the patient. It is important to inspect the damaged area for other damage or injuries. You can call an ambulance and undergo examination in a clinical setting.

First aid:

• freeing your feet from shoes;
• you can take a pain reliever to relieve the condition;
• It is recommended to lift the broken limb and place a cushion (you can improve the flow of blood from the damaged area).

Cooling agents can be applied to provide relief and prevent swelling. Pharmacies sell special ice packs. To prevent frostbite, wrap it in a towel.

Treatment

In most cases, a mid-flight fracture does not require first aid or radical measures. Treatment is based on the use of conservative techniques. Below are therapy methods and recommendations for a quick recovery:

1. It is important to exclude the negative impact of adverse factors that led to the occurrence of march sickness. It is necessary to provide complete rest to the foot, to exclude physical activity that is associated with prolonged pressure on the foot.
2. Application of a plaster splint. Thanks to this, you can significantly relieve pressure on the metatarsal bone and protect yourself from unnecessary movement in the limb.
3. Wearing special shoes and orthopedic insoles. They help redistribute the load so that the bone recovers faster.
4. Physiotherapeutic procedures. After consultation and diagnosis, the doctor may prescribe the patient a course of magnetic therapy, electrophoresis, or ozokerite. These are effective procedures that promote rapid regeneration of limbs and reduce pain.
5. Additionally, ointments and gels are prescribed, which have a local anti-inflammatory and analgesic effect.
6. Taking medications to replenish calcium in the body. This is an important element that is a building material for the body. Calcium helps quickly restore bones.

If treatment is not started in a timely manner, a slow restructuring of the bone structure occurs. If you suspect a fracture, you should consult a doctor and take an x-ray. To accurately determine the damaged area, you can do a tomography.

Consequences

If the patient does not want to be treated and does not follow all the recommendations from the attending physician, he may face the following unpleasant consequences:

• severe deformation of the foot;
• development of arthrosis;
• if the bone heals incorrectly, pain occurs with prolonged loads;
• movement in the foot becomes limited.

If the patient is given the correct treatment, the prognosis for full recovery and recovery is favorable. After therapy, the person will be able to return to their normal lifestyle.

Prevention measures

To prevent serious injuries from occurring in the metatarsal bone, precautions must be taken. The following recommendations can be highlighted:

• you cannot independently diagnose a fracture or the occurrence of a crack (in this case, it is important to seek help from a doctor);
• wearing comfortable shoes that fit exactly;
• avoiding long walks;
• regular visits to the doctor for preventive examinations in order to identify the problem in a timely manner;
• compliance with all recommendations and rules from the orthopedist.

The doctor must take into account the condition of the body and bone tissue. A marching fracture is not fatal to a person, because during the course of life a person encounters various damage to the skeleton and bones of the extremities.

A lot of people are susceptible to a marching fracture, including runners, track and field athletes, army recruits, enthusiasts of various types of fitness and aerobics, devoted lovers of heels, which increase pressure on the forefoot, overly active tourists and shopaholics.

What is a march fracture

A marching fracture is a damage to the metatarsal bone that occurs as a result of excessive and prolonged physical stress on the foot. Marching foot can also occur in people who wear “wrong” shoes, which redistribute the load on the forefoot and thereby overload it. Metatarsal fractures are accompanied by pain and swelling of the soft tissues of the foot. There is no specific treatment method for this type of fracture; at the site of injury, the broken parts of the bones heal on their own. The main thing for the victim is to ensure complete rest for his lower limbs and not to put any unnecessary strain on them.

Causes of marching foot

Causes of a marching foot fracture

Conscripts are considered first on the list of those most susceptible to a march fracture of the metatarsal bone. Harsh army conditions, unusual shoes, sudden overwhelming physical exertion and exhausting forced marches - all this creates unbearable conditions for vulnerable and thin bones; they break from excessive and prolonged pressure. The second metatarsal bone suffers the most, while the third and fourth suffer slightly less. In very rare cases, fractures of the first and fifth metatarsal bones of the foot occur. This fracture was even named after soldiers who selflessly march in military service and break bones in their feet in the process.

Tourists are at risk of a march fracture

The risk group for marching foot fractures includes tourists who experience pain while on vacation and travel, while sightseeing, walking, shopping, and so on. The feet of women who prefer heels are especially affected, even during relaxation. Their metatarsal bones break, unable to withstand the extreme strain.

Marching foot often occurs in avid athletes, both men and women, with extensive experience and sports experience. The reason for this may be intensive preparation for competitions, changing the style of sports shoes, performing complex exercises after a long break, or without prior preparation.

This unpleasant disease also accompanies representatives of certain professions characterized by prolonged standing, walking, carrying heavy objects, and so on. This category includes hairdressers and movers, medical staff, salespeople, waiters, bartenders, tour guides, and so on.

In all cases, the provoking and predetermining factor is the presence of flat feet, physical unpreparedness, as well as wearing uncomfortable and tight shoes. Marching foot can occur in acute or chronic form; one or several metatarsal bones can break on one or both legs. However, the course of the disease almost always ends in complete recovery without complications.

Symptoms and diagnosis of a march fracture

Signs of a marching foot fracture

The main symptoms of a march fracture are pain and slight swelling over the broken bone. However, the X-ray will not show the characteristic fracture line of the metatarsal bones, since they break like a “green stick” - only the internal structures are damaged, and thin bone tissue remains at the top, connecting the edges of the broken bones. As a result, it should take 4 to 6 weeks for the x-ray to clearly record such a fracture. It is worth noting that a marching foot is always.

The most popular way to diagnose a march fracture is palpation. If pressure on the bases of the metatarsal bones brings sharp pain, and swelling of the soft tissues is clearly visible at the site of the suspected fracture, then the diagnosis is obvious - it is marching foot. A fresh fracture can also be detected using magnetic resonance imaging. Using special X-ray modes, the specialist notices a loss of bone tissue, which means there is a gap in the metatarsal bones of the foot.

Foot massage for a marching fracture

Fractures of the metatarsal bones of the foot do not require reduction, unlike many other bones in the human body. Therefore, to treat a march fracture, you do not need to wear an immobilizing cast, and the recovery period will take much less time. Although pressure on the forefoot should be limited, and immediately after recovery, the type of activity that caused the stress fracture should be avoided for a while. Orthopedists recommend using special orthopedic insoles; they will relieve broken bones and make it easier to endure the disease.

And special pain-relieving gels, creams and ointments, which should be applied to the sore spot several times a day, will help cope with swelling, pain and inflammation.

We would like to offer you to watch a video about how you can massage the foot with a cruising fracture.

The prognosis for marching fractures is favorable and often does not have any consequences for the health of the victim. After a complete recovery, a person can completely immerse himself in work, his personal life and hobbies.

A marching fracture is a structural deformation of the metatarsal bone that a person can receive after uneven loads on the foot.

People who prefer to lead an active lifestyle, play sports (most often running), and girls who wear high-heeled shoes are at risk for this injury.

The name of the injury is associated with marching military personnel, who suffer from this problem more often than anyone else, as they constantly engage in active training and forced marches.

Another name for the march fracture injury is Deichlander's disease, which develops on the second metatarsal bone. It, like most existing pathologies and injuries, is associated with great inconvenience in everyday life, but doctors talk about a favorable prognosis.

Causes of the problem

As already mentioned, marching foot is most often diagnosed in people in military service, especially in those who have relatively recently entered this path.

Recruits have to get used to wearing uncomfortable shoes, which most often do not correspond to the actual size of the foot. In addition, the service is associated with a sharp increase in physical stress on the feet. Both of these factors are key reasons.

Whatever physical activity a person engages in, in 70% of cases the greatest load falls on the second metatarsal bone, 20% of the load and, accordingly, the risk of injury - on the third and fourth, and the remaining 10% - on the first and fifth.

Oddly enough, people often get an injury called a “march fracture” while on vacation. Leading a passive, sedentary lifestyle almost all year round, when they go on vacation they decide to radically change something: start jogging along the beach in the morning or walking around local attractions. The foot, in turn, is not prepared for such changes, so it suffers from severe overloads and, unable to withstand them, breaks.

Girls who prefer high heels to comfortable shoes are at risk. How often do we see a lady tripping on an uneven surface, risking falling and damaging herself. But inept movement in heels is not a guarantee of injury. Long-term wearing of such shoes entails overload of the metatarsus, deformation of the foot and fracture of the metatarsal bone, even in comfortable ballet shoes.

Many will agree that professional sport is not so much about health, but, on the contrary, about risks and losses. Thus, many athletes, especially during the period of intensive preparation for upcoming competitions, train for six or even more hours a day. This is a very large load on all organs and systems, so this category of people needs to visit a specialist regularly, every six months, for a full examination.

There are a number of professions that are associated with the risk of getting a marching type fracture. These are teachers, loaders and builders, doctors, and other specialists who have to stand or walk for a long time.

To summarize, we can highlight a list of the main factors that cause the described pathology:

• flat feet regardless of degree;
• uncomfortable shoes: too narrow, hard or small in size;
• uneven distribution of loads that fall on the foot.

Review of Key Symptoms

Having received such a fracture, a person experiences the following signs of injury:

• sharp pain in the middle of the foot, which is most severely felt while walking;
• feeling of uncertainty when walking;
• lameness that lasts for several months;
• swelling of the feet;
• pain in the area of ​​the damaged metatarsus, felt upon palpation.

Unlike other injuries, marching fractures are not associated with symptoms such as: redness of the skin in the area of ​​injury, increased body temperature, subcutaneous hemorrhages, and changes detected in a blood test.

Diagnostic features

A marching type fracture can be classified according to the type of pain.

According to this division, doctors call three groups:

• acute, manifesting itself soon after severe overexertion and associated with gradually subsiding, but very acute pain;
• chronic, the symptoms of which develop gradually, but over time develop into unbearable pain;
• subacute - intermediate state.

Despite the fact that Deichlander's disease, like other types of fractures, is associated with painful sensations, the pathology is not dangerous to human life and health.

In addition, provided proper treatment, the risk of encountering the consequences of injury is negligible. Recovery after the procedures completed does not take much time.

As soon as a person feels pain in the foot, it is necessary to visit a specialist as soon as possible, who will conduct an appropriate study.

Among the methods used for diagnosis, the following are primarily mentioned:

• palpation - feeling the patient’s body, in particular the place that hurts;
• visual inspection;
• interviewing the patient for complaints;
• laboratory research.

After this, the doctor will be able to make a diagnosis and prescribe medications that are effective in a particular case (stimulating the healing of bone tissue, eliminating pain and discomfort) and physiotherapeutic procedures.

The difficulty of diagnosing a march fracture is due to the fact that the fracture line is not visible on an x-ray, since the metatarsal bones do not break completely, but only become covered with cracks. This phenomenon in medicine is called a “green branch”.

The “green twig” type of fracture is one of the safest, since the periosteum itself does not lose its integrity, and the damage is quickly repaired. Most often found in children.

X-rays show such a fracture only after five to seven weeks, which is why Deichlander's disease is called a hidden pathology.

How, then, to carry out diagnostics? Let's return to the list of basic methods: the doctor feels the potential fracture site and evaluates the pain that the patient describes.

Another diagnostic method that doctors sometimes use is magnetic resonance imaging, which allows them to find out which metatarsal bone the fracture occurred in.

The need for MRI arises if palpation causes severe pain, and slight inflammation is observed in the localized area.

Specific Treatments

Doctors do not offer any special methods for treating a march fracture, since with any such injury a callus naturally appears, that is, healing and fusion.

The only thing a person can do is to help his body by leaving it alone and relieving the damaged limb of unnecessary stress. There is no need to immobilize the limb for such a fracture.

You can use special orthopedic insoles to help relieve or properly distribute the load. With their help, it is easier to endure the healing process and speed up bone fusion.

If necessary, painkillers and anti-inflammatory drugs (ointments, creams and tablets) are prescribed.

A marching fracture is one of the safest injuries of this kind, but you should not treat it with disdain. Proper diagnosis and treatment will help you get rid of pain faster.