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Lisfranc joint injury
8%
210/2761
Cuneiform stress fracture
10%
263/2761
Second metatarsal base stress fracture
76%
2098/2761
Plantar fascia strain
1%
40/2761
First metatarsal base stress fracture
5%
133/2761
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Stress fractures in ballet dancers occur most frequently at the second metatarsal base. The radiograph shown in Figures A demonstrates a chronic stress reaction at the base of the second metatarsal typical of these injuries when delayed on presentation. MRI, shown in Illustration A and B, can be obtained to help confirm the diagnosis. O'Malley et al identified 51 professional dancers (64 fractures) who sustained a stress fracture at the base of the second metatarsal. Delayed menarche was common in those affected, and the usual location of the fracture was at the proximal metaphyseal-diaphyseal junction of the second metatarsal. Treatment consisted of a short leg walking cast for 6 patients, and a wooden shoe and symptomatic treatment for the remainder. The patients returned to performance at an average of 6.2 weeks following diagnosis, with 14% reporting continued pain with dancing. No patients required bone grafting for persistent symptoms. This patient went on to develop a nonunion of her stress fracture requiring fixation, which is shown in Illustration C.
2.9
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