Deutschlander's disease (marching fracture, marching foot): causes, symptoms and treatment. Marching fracture of the metatarsal bone Causes of the marching foot

Deutschlander's disease is damage to the metatarsal bones. 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 the structure of the bones. To identify such a disease is sometimes quite difficult. Sometimes even specialists mistakenly diagnose this disease as osteomyelitis or a bone tumor. This pathology is otherwise called a marching foot, as it is often found in young soldiers after long forced marches.

Pathogenesis

The metatarsus is called the middle part of the foot. It is located between the tarsal bone and 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 greatest load. On x-rays, the changes look like one part of the bone has partially separated from the other. Therefore, the disease is often called a marching fracture.

However, this pathology does not occur as a result of trauma. With it, there is no complete separation of the bone. This disease only outwardly looks like an incomplete fracture. Over time, the lesions 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. The risk group also includes people whose activities are associated with increased stress on the legs:

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

Wearing uncomfortable shoes can provoke Deutschlander's disease. Pathological changes in the bones of the metatarsus 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 a heavy load on the legs (for example, a long hike or forced march). The patient has pain in the foot and swelling above the bones of the metatarsus. The discomfort can be quite intense.

The primary chronic form of the disease is more common. Symptoms of bone damage in this case increase gradually. At first, the pains are mild and do not interfere with movement. The patient often wonders why the foot hurts, because he did not have any injuries.

Over time, the pain becomes intense and unbearable. The patient begins to limp heavily. 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 swelling. When pressed, pain is noted.

Very rarely, a slight reddening of the skin is observed in the area of edema. At the same time, the general well-being of the patient is not disturbed, there is neither high temperature nor weakness.

Such symptoms may disturb the patient for 3-4 months. Then the pain subsides, and the pathology ends with recovery. The altered areas of the metatarsus are tightened with normal bone tissue. We can say that this disease always ends in self-healing and does not cause complications. However, therapy should not be neglected. Pain in this pathology can be very severe. Often, the patient cannot move normally due to discomfort.

Diagnostics

The treatment of this pathology is carried out by a traumatologist or orthopedist. The most reliable diagnostic method is a foot x-ray. You can see the following changes in the picture:

At the beginning of the disease, changes in the structure of bone tissue are visible. You can see an oblique or transverse light strip. It is in this area that the pathological restructuring of the bone occurs. It looks a lot like a fracture. The bone appears to be divided into two parts. However, unlike a true fracture, there is no tissue displacement.
In the future, growths appear around the site of the lesion, and then a callus is formed. The light strip gradually disappears.
At the stage of recovery, the callus resolves. However, the bone remains thickened.

An important role in the diagnosis of the disease is played by the collection of anamnesis. It must be established that the patient had no history of limb injuries.

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

Treatment Methods

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

With 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, paraffin applications on the metatarsal area are shown. In the future, patients are advised to use shoe insoles and avoid excessive stress on the lower extremities.

Prevention

It can be concluded that this disease is easily cured and does not give complications. However, it significantly reduces the patient's quality of life. Therefore, it is necessary to take measures to prevent pathology.

If human activity is associated with a load on the legs, then you need to periodically undergo a course of therapeutic massage. At home, it is useful to do foot baths after a working day. For long walks, wear comfortable shoes with low heels. Recruit soldiers need regular check-ups with an orthopedic doctor. This will help avoid damage to the metatarsal bones.

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

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

Whatever physical activity a person is engaged 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.

The foot, in turn, is not prepared for such changes, therefore it suffers from strong 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 stumbling on an uneven surface, risking falling and hurting herself.

But inept movement in heels is not a guarantee of injury. Prolonged wearing of such shoes entails an overload of the metatarsus, foot deformity and a fracture of the metatarsal bone, even in comfortable ballet flats.

This is a very big load on all organs and systems, so this category of people needs to visit a specialist regularly, once every six months, for a complete examination.

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

Summing up, we can distinguish 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.

Pathology is most often diagnosed in the military, especially among recruits. This is due to the use of uncomfortable shoes, which, in most cases, simply do not match the size of the soldier.

Also, the appearance of the disease contributes to a sharp increase in the load on the feet. All of these factors are key.

In about 70% of cases, the second metatarsal bone suffers, for the reason that it is the main load. In 20%, the third and fourth are damaged. In the remaining 10%, the first and fifth bones are deformed.

The picture will help you understand:

Very often, a march fracture overtakes people on vacation. This is due to the fact that the vast majority of residents lead a passive lifestyle, and during the holidays they decide to change this by starting to travel on foot and walk long distances.

But the foot cannot cope with such overloads, which leads to bone fractures.

Often this pathology is also found in girls who love long heels. In such female representatives, the risk of fracture is high even during the rest period.

Very often, such a fracture can be found in athletes, especially during the period of active preparation for competitions, when a person trains for about 6 hours a day. That is why all beginners and professional athletes need to be examined by a specialist every six months.

Of course, there is a separate group of citizens whose professions are at risk. Basically, this is a job during which people are on their feet all day. This includes teachers, doctors, loaders, builders, etc.

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 strongly felt in the process of walking;
feeling of uncertainty when walking;
lameness, which is delayed for several months;
swelling of the feet;
pain in the area of the damaged metatarsus, felt on palpation.

Unlike other injuries, marching fractures are not associated with symptoms such as: reddening of the skin in the area of injury, fever, subcutaneous hemorrhages, changes found in the blood test.

The main symptoms of a marching fracture are painful sensations in the area of pathology and an almost imperceptible swelling of the defective bone.

A distinctive feature of such damage is that the fracture line will not be visible in the X-ray image. This is due to the fact that the deformation of the bones occurs according to the type of "green branch".

The main signs of a marching foot are slight pain and swelling in the affected area. An x-ray taken during the acute period of the disease reflects the characteristic sites of fractures.

Bone damage occurs according to the green line principle - only deep bone tissues are broken, while superficial ones remain unchanged. These signs can be seen in detail in the photo.

A photo. Closed fracture of the fifth metatarsal bone in the picture

Healing begins 1–2 months after injury. A fatigue fracture is always closed.

The disease begins either acutely - immediately after a large overload of the foot, or gradually - pain develops in the forefoot, which interferes with walking. There is a very dense, painful swelling on the back of the foot.

X-ray detectable changes in a marching fracture appear only after a month, sometimes later. In the middle third of the diaphysis of the second, less often the third metatarsal bone, a transverse line of enlightenment is found, shrouded in a spindle-shaped thickening of the ossified periosteum.

Features of diagnostics

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

According to this division, doctors call three groups:

acute, manifesting itself soon after a strong overexertion and associated with gradually subsiding, but very acute pain;
chronic, the symptoms of which develop gradually, but eventually develop into unbearable pain;
subacute - an intermediate state.

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

In addition, with proper treatment, the risk of experiencing the consequences of an 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 in the near future, who will conduct an appropriate study.

Among the methods that are used for diagnosis, the following are primarily called:

palpation - feeling the patient's body, in particular the place that hurts;
visual inspection;
questioning the patient about complaints;
laboratory research.

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

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

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

An X-ray image shows such a fracture only after five to seven weeks, which is why Deichlander's disease is called a latent pathology.

How, then, to diagnose? We 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 you to find out in which metatarsal bone the fracture occurred.

Treatment

Treatment is conservative. It comes down to rest and unloading of the limb, its immobilization for 3-4 weeks. plaster bandage, the appointment of thermal physiotherapy, massage and physiotherapy exercises.

The prognosis is favorable.

Prevention consists in strict medical supervision of recruits (treatment of flat feet), as well as wearing well-fitted, rational shoes.

Prevention

In order to prevent the development of the disease, one should wear comfortable shoes with orthopedic insoles, regularly undergo preventive examinations, promptly identify and treat functional insufficiency of the feet, and exclude periods of long walking.

Preventive measures

One of the main reasons that increases the risk of a march fracture is a lack of calcium in the human body. This is due either to malnutrition or insomnia. Since the hormones that provoke the absorption of calcium into the bone are produced only during periods of sleep. Therefore, to prevent a fracture, it is necessary to eat right and have good sleep. Experts also recommend the following:

In order not to encounter a marching fracture, it is necessary to constantly control the load, increasing it gradually. If a person is engaged in different types of exercises, then they should be alternated, for example, running with cycling, strength training with swimming, etc. Muscles and bones should be given rest and time to recover from exercise.

During training, it is necessary to use high-quality and correct shoes, as well as elastic bandages.

A marching 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. Pathology is also characteristic of athletes who subject themselves to excessive physical exertion.

A marching fracture of the metatarsal bone often occurs due to uncomfortable shoes, overexertion during 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, 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.

The mechanism of development of the marching foot

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

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

Who is at risk

Marching fractures of the foot or leg occur in people of different professions. Various factors influence the occurrence of this disease. The risk group includes:

Young conscripts. A person gets into special conditions under which it may be necessary to wear uncomfortable shoes. Recruits have to deal with excessive physical stress. These factors contribute to the fact that single or multiple cracks appear on thin bones.
Professional tourists and outdoor enthusiasts. In this case, a person is faced with a fatigue march fracture. He has to walk for a long time over rugged mountainous terrain. The entire load falls on the legs - body weight, backpack and additional equipment.
Athletes. When a person prepares for a competition, he loads himself with grueling workouts. As a result, there is a high risk of injury.
People who spend most of their time on their feet. These can be hairdressers, sellers, movers, medical workers, couriers.

Pathology occurs as a result of functional overload of the foot. It is not associated with an inflammatory process or oncological neoplasms.

Symptoms and stages

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

Acute

A marching fracture of a bone of an acute form is manifested by acute pain. There is a strong overvoltage and slight swelling. The sensation of soreness is permanent, and begins to gradually subside 2-3 days after the injury.

subacute

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

Chronic

Soreness begins to increase gradually. After a while, a person cannot walk on his own, because there is a sharp pain. The foot becomes very swollen, making it difficult to wear shoes.

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

First aid

Upon receipt of a marching bone fracture, it is necessary to put the leg on a hard surface and ensure complete rest for the patient. It is important to inspect the damaged area for other damage and injuries. You can call an ambulance and undergo an examination in a clinical setting.

First aid:

release of the foot from the shoes;
you can take an anesthetic drug to alleviate the condition;
it is recommended to raise the broken limb and place a roller (you can improve the outflow of blood from the damaged area).

Coolants can be applied to relieve the condition and prevent swelling. Pharmacies sell special ice packs. Wrap it in a towel to prevent frostbite.

Treatment

In most cases, a march fracture does not require first aid, as well as drastic measures. Treatment is based on the use of conservative techniques. The following are therapies and recommendations for a quick recovery:

It is important to exclude the negative impact of unfavorable factors that led to the emergence of marching disease. It is necessary to provide the leg with complete rest, to exclude physical exertion that is associated with prolonged pressure on the foot.
Plaster casting. Thanks to this, you can significantly relieve pressure on the metatarsal bone, protect yourself from unnecessary movement in the limb.
Wearing special shoes and orthopedic insoles. They help redistribute the load so that the bone recovers faster.
Physiotherapy procedures. After consultation and diagnosis, the doctor may prescribe a course of magnetotherapy, electrophoresis, ozocerite for the patient. These are effective procedures that contribute to the rapid regeneration of the limbs and the reduction of pain.
Additionally, ointments and gels are prescribed, which have a local anti-inflammatory and analgesic effect.
Taking drugs to replenish calcium in the body. This is an important element that is a building material for the body. Calcium helps in the rapid regeneration of bones.

If treatment is started late, 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.

Effects

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 deformity of the foot;
development of arthrosis;
if the bone grows together incorrectly, soreness appears during prolonged loads;
movement in the foot becomes limited.

If the patient is prescribed the right treatment, the prognosis for full recovery and recovery is favorable. After therapy, a person will be able to return to their usual way of life.

Prevention measures

Precautions must be taken to prevent serious injury to the metatarsal bone. The following recommendations can be highlighted:

it is impossible to independently diagnose a fracture or the occurrence of a crack (in this case, it is important to consult a doctor for help);
wearing comfortable shoes that fit true to size;
exclusion of long walks;
regular visits to the doctor for a preventive examination 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 deadly for a person, because in the course of life a person is faced with various lesions of the skeleton and bones of the limbs.

A marching fracture is a metatarsal bone injury that occurs as a result of excessive and prolonged physical exertion on the foot. A marching foot can also occur in people who wear “wrong” shoes, redistributing the load on the forefoot and thereby overloading it. Metatarsal fractures are accompanied by pain and swelling of the soft tissues of the foot.

Causes of the march foot

Causes of a marching fracture of the foot

The first in the list of the most prone to a march fracture of the metatarsal bone are conscripts. Harsh military conditions, unusual shoes, sudden unbearable physical exertion and exhausting forced marches - all this creates unbearable conditions for the vulnerable and thin bones of the foot, they break from excessive and prolonged pressure.

The second metatarsal bone suffers the most, the third and fourth are slightly less stressed. In very rare cases, a fracture of the first and fifth metatarsal bones of the foot occurs. This fracture was even named after the soldiers who selflessly march in military service and break the bones of the feet in the process.

Tourists at risk of march fracture

The risk group for marching foot fractures includes tourists who experience excessive stress on their legs during leisure and travel, while sightseeing, hiking, shopping, and so on. The legs of women who prefer heels are especially affected, even in resting conditions. Their metatarsal bones break, unable to withstand the strongest overstress.

Often, a marching foot also occurs in avid athletes, both men and women, with extensive experience and sports experience. The reason for this may be intensive preparation for the competition, 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 stay on their feet, walking, carrying weights, and so on. This category includes hairdressers and porters, 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. A marching foot can occur in an 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.

With Deichlander's disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. Pathological restructuring of bone tissue in this case is due to changed mechanical and static-dynamic factors. The second metatarsal bone is most often involved in the process, less often - III, even more rarely - IV and V.

Usually one bone is affected, although both simultaneous and consecutive lesions of several bones in one or both feet are possible. It has been established that the marching foot is a special type of bone tissue transformation not associated with tumor or inflammation.

At the same time, the views of experts on the nature of the damage are still divided. Some believe that the restructuring of the bone is accompanied by an incomplete fracture or the so-called "microfracture". Others believe that the term "marching fracture" should be considered outdated and untrue, since there is only local resorption of bone tissue, which is subsequently replaced by normal bone without the formation of a callus.

Causes of the problem

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

Oddly enough, often people get an injury with the name "marching fracture" on vacation. Leading a passive, sedentary lifestyle almost all year round, when they go on vacation, they decide to radically change something: start running in the morning along the beach or walk around the local attractions. The foot, in turn, is not prepared for such changes, therefore it suffers from strong 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 stumbling on an uneven surface, risking falling and hurting herself. But inept movement in heels is not a guarantee of injury. Prolonged wearing of such shoes entails an overload of the metatarsus, foot deformity and a fracture of the metatarsal bone, even in comfortable ballet flats.

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

Summing up, we can distinguish 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.

Stress fractures can occur in athletes, dancers, movers, and others whose bones are subject to excessive stress. Often a stress fracture occurs in people who are just starting sports activities, but incorrectly calculate the loads. Their muscles and bones are not yet prepared properly, which is why various injuries of the legs, arms and back occur.

A crack in the bone can form not only due to severe overstress. People with osteoporosis are very susceptible to stress fracture. With this disease, the structure of the human bone changes, it becomes thin and brittle, so even a slight load can cause a fatigue fracture.

Reasons for the occurrence of a march fracture include:

Low mobility in daily life followed by a large load;
Obesity, or vice versa, lack of weight due to poor nutrition or due to other problems in the body;
Diseases such as osteoporosis, osteomyelitis, bone tuberculosis, oncology;

Among athletes, a fatigue fracture is more often observed in football players, jumpers, runners, tennis players, gymnasts, weightlifters, and fitness trainers.

Going on a forced march, recruits are not even aware of the load that lies ahead of them. At home, few of them went in for sports, or moreover, they ran long distances in the morning. That is why unaccustomed to

the bones of the feet can not withstand the strong load and break. Probably due to the fact that this type of injury is most often found in soldiers on forced marches, it was called marching.

For the same reason, there is a violation of the integrity of the bone in those who first decided on a long trip. Not commensurate with their strength and sports training, many lovers of such walks leave the race precisely because of this type of injury.

Marching fracture of the cause

In addition to the military and athletes, representatives of the beautiful half of the world's population also face the problem. Lovers of high heels, as well as soldiers, are at risk. Moreover, they do not even need to walk long distances for this. Narrow shoes and high heels do their job - the bones of the feet, subject to constant compression and stress, deform and become brittle, brittle.

Another main risk group is athletes. By increasing the amount of loads and training before the competition, they can overdo it, which also leads to a metatarsal injury.

Even a small stone that fell under the foot when a person was walking or running can contribute to a marching fracture. Sometimes bones can also be damaged as a result of a fall or dislocation of the foot. If against this background a fracture of one of the metatarsal bones has formed, then it will also have the name marching. The second, third and fourth fingers are most often injured. They are the thinnest and longest, and are most involved when walking.

A huge number of people who lead an active lifestyle, are lovers of yoga, jogging, girls in high heels, etc. can get such a fracture.

The marching break gets its name from the marching military. In this category of citizens, this pathology is most often found, especially after active training or forced marches.

A marching fracture is a structural deformity of the metatarsal bone due to uneven loads on the foot.

Remove all factors that provoke overload of the foot. That is, the rest mode is assigned to the foot. At first, you should try not to step on a sore leg.

Pathology is most often diagnosed in the military, especially among recruits. This is due to the use of uncomfortable shoes, which, in most cases, simply do not match the size of the soldier. Also, the appearance of the disease contributes to a sharp increase in the load on the feet. All of these factors are key.

Very often, a march fracture overtakes people on vacation. This is due to the fact that the vast majority of residents lead a passive lifestyle, and during the holidays they decide to change this by starting to travel on foot and walk long distances. But the foot cannot cope with such overloads, which leads to bone fractures.

Often this pathology is also found in girls who love long heels. In such female representatives, the risk of fracture is high even during the rest period.

Very often, such a fracture can be found in athletes, especially during the period of active preparation for competitions, when a person trains for about 6 hours a day. That is why all beginners and professional athletes need to be examined by a specialist every six months.

Flat feet of various degrees;

Unsuccessfully purchased shoes that are uncomfortable to walk in;

Uneven load on the foot.

With acute everything is clear. It begins to manifest itself some time after the overstrain has occurred, while the pain will be acute, subsiding over time.

Chronic, in turn, is characterized by the fact that the pain increases gradually and eventually develops into unbearable pain.

No matter how inconvenient this pathology is, it does not pose a danger, since there are practically no consequences from such an injury. In addition, recovery is relatively fast.

What can cause a march fracture of the metatarsal bone can be understood from the name of the disease. The disease was first described in recruits in the army. An abrupt change of scenery, great physical exertion, uncomfortable shoes and, of course, marches with a clear step - all this provokes the formation of small cracks in the thickness of the metatarsal bone.

Normally, the body can restore everything on its own within a few days, but this requires rest. If adverse factors are repeated daily, then regeneration simply cannot cope and the metatarsal bone suffers more and more.

Tourists overcoming hundreds of kilometers on foot with a huge luggage behind them.
Professional athletes who push the body to the limit in daily workouts.
Lovers of long walks on fashionable shoes with high heels. In this case, the foot loses its shock-absorbing properties, and the maximum load falls on the thin metatarsal bones.
Representatives of professions that stand on their feet for a long time: sellers, hairdressers, tour guides, bartenders, waiters, etc.
Persons with osteoporosis (decrease in bone density) - for the development of a marching foot, sometimes a slight load is enough.

Clinical picture and forms of the disease

There are two forms of Deichlander's disease:

acute - occurs 2-4 days after exposure to the load (more rare form);
primary chronic- develops slowly on the rise.

Patients experience severe pain in the central part of the foot, which is sometimes simply unbearable. At the same time, the gait is disturbed, the person begins to limp and tries not to step on the sore leg.

As a result of the examination, a dense swelling and edema are found in the affected area (on the outside of the foot). The sensitivity of the skin in this area increases. Rarely, redness of the skin occurs.

An interesting fact is that with Deichlander's disease there are no characteristic symptoms, such as a high temperature or a change in the biochemical blood picture.

The average time for the development of the disease is several months, but it can pass much faster. Pain is present throughout the course of the disease.

The mechanism of development of the marching foot

The risk group includes recruit soldiers who, when entering a new environment for them, turn out to be completely unprepared for long intensive training, people whose professions are related to standing on their feet, carrying weights, professional athletes.

Very often there are cases when a person goes on a hike without proper preparation and in conditions of long walking and carrying a heavy load, becomes a victim of this disease.

Symptoms of a march fracture

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

sharp pain in the middle of the foot, which is most strongly felt in the process of walking;
feeling of uncertainty when walking;
lameness, which is delayed for several months;
swelling of the feet;
pain in the area of the damaged metatarsus, felt on palpation.

Unlike other injuries, marching fractures are not associated with symptoms such as: reddening of the skin in the area of injury, fever, subcutaneous hemorrhages, changes found in the blood test.

In everyday life, a stress fracture may not give itself away, except for minor pain, which people often write off as simple leg fatigue. Pain is aggravated by physical exertion and is so strong that the victim has to take an anesthetic.

The following symptoms suggest a stress fracture:

The pain syndrome is undulating. It becomes more pronounced during the period of human activity and subsides in a calm state.
When a microcrack occurs, the tissues of the limb swell strongly.
The injury site is painful if a person feels it.
Sometimes there are small hematomas.

It is worth noting once again that these signs cannot give a 100% guarantee that a person has a marching fracture, since they can be present in many other injuries, as well as diseases. To make an accurate diagnosis, the victim must undergo a complete examination.

Signs of a marching fracture of the foot

The main symptoms of a march fracture are pain and slight swelling over the broken bone. However, the characteristic line of metatarsal bones fracture will not be visible on the x-ray, as they break like a “green branch” - only internal structures are broken, and thin bone tissue remains at the top, connecting the edges of the broken bones.

The most popular method for diagnosing a march fracture is palpation. If pressure on the base of the metatarsal bones brings a sharp pain, and swelling of the soft tissues is clearly visible at the site of the alleged fracture, then the diagnosis is obvious - this is a marching foot. A fresh fracture can also be detected using magnetic resonance imaging. Through special radiography modes, the specialist notices rarefaction of bone tissue, which means that there is a gap in the metatarsal bones of the foot.

Treatment of a march fracture

Foot massage for a marching fracture

A fracture of the metatarsal bones of the foot does not require reduction, unlike many other bones in the human body. Therefore, for the treatment of a march fracture, it is not necessary to wear an immobilizing cast, and the recovery period will take much less time. Although you should limit the pressure on the forefoot, and immediately after recovery, it is necessary to exclude for some time the type of activity that provoked the fatigue bone fracture. Orthopedists recommend using special orthopedic insoles, they will unload broken bones and make it easier to transfer the disease.

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

We would like to offer to watch a video on how to massage the foot with a marching fracture

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

The main symptoms of a violation of the integrity of the metatarsal bone are pain in the foot area, swelling of the tissues, swelling, and pain when touched. If physical activity continued for some time after the formation of a fracture, then deformity of the foot may be observed. If, for example, an athlete, after the formation of a crack, continued to give an increased load, then in this case even an injury with displacement, blueing and bruising can form.

The main symptoms of a marching fracture are painful sensations in the area of pathology and an almost imperceptible swelling of the defective bone.

A distinctive feature of such damage is that the fracture line will not be visible in the X-ray image. This is due to the fact that the deformation of the bones occurs according to the type of "green branch".

It is now well known that the march fracture is one of the localizations of the restructuring zones described by Looser. The reason for the restructuring is excessive mechanical overload of the bone tissue. Such bone overload can occur not only as a result of a significant excess of the size of the normal load, as is observed in athletes during competitions, during overtraining, but also during normal loading in adverse functional conditions, for example, when walking in high heels, with flat feet or with a decrease in endurance. bone tissue (rickets).

During normal physical work or training, a gradual hypertrophy of the loaded sections of the skeleton occurs, as is usually observed in manual workers, athletes or ballerinas. In the latter, hypertrophy of the predominantly loaded III metatarsal bones is especially noticeable. With an excessive, unbearable load on the bones, which exceeds the normal reparative capabilities, restructuring processes develop.

If the etiological factor of restructuring - mechanical overload of the bone - is proven, then the pathogenesis of restructuring remains unclear. G. I. Turner, putting forward the neurotrophic theory, considered the restructuring of the bone during marching fractures as a secondary act, which is a consequence of the primary irritation of the nerves under the influence of prolonged fatigue of the tense muscular and ligamentous apparatus.

A number of orthopedists believe that the primary factor in bone restructuring is the summation of microtraumas, which entails molecular shifts and even microfractures.

The pathoanatomical essence of a marching fracture is limited resorption of the bone substance, followed by the replacement of the old bone with a new one. Initially, the restored bone is poor in lime, but later on a dense compact bone is created. The periosteal reaction is especially pronounced. At the end of the restructuring, which lasts from 3 to 5 months, the metatarsal usually returns to its original shape, the fusiform thickening disappears, but the bone remains thicker and denser.

The final favorable outcomes of restructuring in the area of Looser's zones give grounds to consider them as a rational resection of bone tissue for excessive load, since as a result of restructuring, the bone becomes more enduring and adapted to new staticodynamic conditions. It is necessary to observe a significant strengthening of the metatarsal and other bones after the formation of zones of restructuring.

There are two clinical forms of the disease: acute and primary chronic. The first is observed less frequently, develops 2-4 days after a significant overvoltage (for example, a long forced march). The second arises gradually, gradually. Her symptoms are less pronounced. There is no history of acute trauma with a marching foot. Patients with this diagnosis complain of intense, sometimes unbearable pain in the midfoot.

Lameness appears, gait becomes uncertain, patients try to spare the injured limb. On examination, there is local edema over the middle metatarsal bone and more dense swelling in the affected area. Skin sensitivity in this area increases. Hyperemia (reddening of the skin) is noted quite rarely and is never pronounced.

Patients also never experience general symptoms: there is neither an increase in body temperature, nor a change in the biochemical or morphological picture of the blood. Pain can persist for weeks or even months. The average duration of the disease is 3-4 months. The disease ends with a complete recovery.

Diagnostic methods

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

According to this division, doctors call three groups:

acute, manifesting itself soon after a strong overexertion and associated with gradually subsiding, but very acute pain;
chronic, the symptoms of which develop gradually, but eventually develop into unbearable pain;
subacute - an intermediate state.

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

In addition, with proper treatment, the risk of experiencing the consequences of an 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 in the near future, who will conduct an appropriate study.

Among the methods that are used for diagnosis, the following are primarily called:

palpation - feeling the patient's body, in particular the place that hurts;
visual inspection;
questioning the patient about complaints;
laboratory research.

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

An X-ray image shows such a fracture only after five to seven weeks, which is why Deichlander's disease is called a latent pathology.

How, then, to diagnose? We return to the list of basic methods: the doctor feels the potential fracture site and evaluates the pain that the patient describes.

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

The diagnosis is exposed on the basis of interrogation, survey and data of a X-ray analysis. In this case, the picture obtained during the X-ray examination is of decisive importance.

In case of Deichlander's disease in the area of the diaphysis of the affected metatarsal bone (sometimes closer to the head, sometimes closer to the base, depending on the localization of the most functionally overloaded area), a change in the structural pattern is revealed. An oblique or transverse band of enlightenment is determined (Loozer's area of enlightenment) - the area of bone remodeling.

Subsequently, periosteal growths appear around the affected bone section. At first they are thin and tender, then they are dense, similar to a spindle-shaped bone callus. Later, the zone of enlightenment disappears, sclerosis occurs.

Over time, the periosteal layers dissolve. In this case, the bone forever remains thickened and compacted. The defining features are the absence of acute trauma, typical localization of damage, and the presence of a restructuring zone in the absence of displacement of fragments and maintaining the correct shape of the bone.

It should be borne in mind that during the first few days or weeks, radiological signs of the disease may be absent. Therefore, with characteristic symptoms, it is sometimes necessary to perform several radiographs with a certain time interval.

The word "fracture" most often means an acute disease with characteristic symptoms. It is usually preceded by an injury (falling, hitting, hitting a car, etc.). However, few have heard of a mid-flight fracture of the foot (Deichlander's disease, a stress fracture). Moreover, most people do not suspect that they themselves have encountered this disease.

If you perform an X-ray examination in the first weeks after exercise and the onset of pain, then you can not find anything. With a typical fracture, the cortical layer of the bone is damaged and displacement often occurs, which is clearly visible in the picture. A marching fracture is a local damage to the bone, the pain is localized in the center, and a slow restructuring of its structure is observed.

Characteristic signs of a march fracture on the radiograph:

The area of enlightenment in the form of a strip located across the bone is the zone where, as a result of restructuring, the old tissue does not have time to be replaced by a new one in a timely manner.
At first glance at the marching foot, one might get the impression that the bone is divided into 2 parts that differ from each other in their structure. They are never offset from each other. Displacement of bone fragments is always a sign of an ordinary traumatic fracture.
Around the area of enlightenment, the bone can change its shape and resemble a spindle. This is a consequence of constant regenerative processes. A doctor, seeing such a thickening, can regard it as a formed callus - a consequence of a long-standing fracture.

Tomography is a more expensive, but informative method in determining a march fracture, since it allows you to examine the bone in layers and identify pathology even in its very center.

Treatment of a march fracture

Doctors do not offer any special methods for treating a marching 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, leaving it alone and relieving the injured limb from unnecessary loads. It is not necessary to fix the limb with such a fracture.

You can use special orthopedic insoles that contribute to the removal or proper distribution of the load. With their help, it is easier to transfer the healing process and accelerate 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 allow you to get rid of the pain syndrome faster.

Conservative treatment consists of the following steps:

Bed rest. The patient should rest as much as possible and move less. If you need to go to the toilet, you should use a cane so as not to lean heavily on the injured limb. To relieve swelling, the leg should be pulled with an elastic bandage, but observe the color of the skin in order to notice a violation of blood circulation in time.
Wearing orthopedic shoes or individual insoles. Insoles are preferable because they are made individually, taking into account all the features of the human foot and help to evenly distribute the load on the entire leg. If there is a crack in the tibia, then shoes with a high back will securely fix the ankle, thereby protecting it from overstrain. Shoes and insoles should be worn from the moment when the patient is already allowed to get up.
Immobilization. If the crack is very large, then it is necessary to apply a plaster cast, because the bone can break completely at any time. In addition, with a high degree of severity of damage, ligaments are very often damaged, which is an indication for the imposition of gypsum.
Medical therapy. The patient is prescribed analgesics, drugs that relieve the inflammatory process and accelerate the regeneration of bone tissue. It is obligatory to take calcium, and in winter vitamin D. In summer, vitamin D is synthesized in the body under the influence of ultraviolet rays, therefore the patient is recommended to spend enough time outdoors in sunny weather, without burdening the limb.
Physiotherapy. Starting from the third day of treatment, the patient must undergo physiotherapy. Electrophoresis, magnetic therapy, paraffin applications accelerate the fusion of the crack, activate metabolic processes, stimulate blood circulation in the area of damage.

In rare cases, with very large and wide cracks, when there is a risk of a complete fracture, the patient undergoes an operation, during which a metal plate is applied to the bone, which fastens the crack and prevents it from breaking.

There are three types of treatment for march fractures.

Ensuring peace and complete absence of stress on the foot;
Complete immobilization of the foot (gypsum bandage or splint);
Operative surgical intervention;

The first treatment option is used when the injury was classified as closed without displacement, that is, it is a fissure.

If the doctor saw a displacement on the x-ray, or just a pronounced fracture, then the lower limb must be immobilized and protected from accidental loads. For this, a plaster bandage, or splint, is recommended.

Surgical intervention is indicated when a fracture with a displacement that needs to be repaired, or when trauma has formed fragments of the metatarsal bone. Such cases are quite rare, often having a traumatic character.

In fact, a march fracture is not as scary as it might seem at first glance. The main thing to remember is one rule: if there is pain or swelling in the area of the metatarsus, you need to contact a traumatologist. And in order to avoid complications of a marching fracture, follow all his recommendations exactly.

At the request of the patient, the doctor may prescribe various kinds of drugs, ointments, creams, etc. against pain and inflammation.

Important. It is forbidden to use ultrasound and heat to treat such a fracture. Since these events interfere with the natural fusion of bones.

A person with such a disease is also prescribed static gymnastics. This type of exercise helps to relax the muscles of the lower leg.

Prevention of marching fractures lies in proper training, in wearing rationally built and well-fitting shoes.

Traumatologists are engaged in the treatment of the marching foot. Treatment is strictly conservative, surgical interventions are contraindicated. In the acute form, a plaster splint is applied to the patient and bed rest is prescribed for a period of 7-10 days. After the acute manifestations of the disease subside, as well as in the primary chronic form of the disease, massage and thermal (paraffin applications, baths) and other physiotherapeutic procedures are prescribed. Subsequently, patients are advised to use removable insoles and avoid long walks.

Prevention consists in the selection of comfortable shoes, the choice of reasonable physical activity and careful medical supervision of recruit soldiers.

The marching foot is not deadly and does not require emergency drastic measures. Usually doctors manage conservative methods.

The main thing is to exclude the influence of an unfavorable factor that provoked a marching disease. The patient is freed from any physical exertion that is associated with prolonged support on the foot.
Gypsum splint - allows you to unload the metatarsal bones and prevent unnecessary movements in the limbs, providing maximum rest to the affected organ.
Special orthopedic insoles or shoes rationally redistribute the load on the marching foot in such a way that the nearby bones take over everything and provide conditions for recovery.
Physiotherapy - electrophoresis, magnet, ozocerite. All these procedures accelerate regeneration and reduce pain.
Locally, you can use gels and ointments with painkillers and anti-inflammatory drugs. This allows you to quickly eliminate pain and eliminates the need to take pills by mouth (all anti-inflammatory drugs are harmful to the stomach).
Calcium preparations - supply the body with the building material necessary for bone restoration.

Approach to therapy

With a fatigue marching fracture, conservative treatment is used. The goal of therapy is to relieve acute pain symptoms and eliminate the main mechanism that provoked the disease. Surgical intervention in this case is never used.

First of all, a plaster splint is placed on the patient's foot and bed rest is prescribed, which should be at least a week. A person must be freed from prolonged standing and walking, because the injured leg needs complete rest. After the pain becomes less intense, it will be possible to apply the following methods:

massage;
thermal baths;
paraffin or ozokerite applications;
warming ointments and gels (for example, Fastum-gel);
sometimes non-steroidal drugs are prescribed to relieve swelling and eliminate pain: Aspirin, Ibuprofen, Voltaren;
foot baths using sea salt or herbal tea;
physiotherapy exercises to relax the muscles of the lower leg, while the exercises should not involve the feet.

Also, without fail, in the rehabilitation period, the patient is prescribed the wearing of orthopedic insoles and instep supports.

Possible Complications

Significant hypertrophy of the bones of the metatarsus in areas located closer to the fingers. As a result, nerve branches can be involved in the process and pain can significantly increase.

The development of osteoporosis and a predisposition to a common fracture even with minor trauma.

Osteoarthritis of the small joints of the foot is a progressive degenerative disease that usually occurs in older patients. Deformation of the arch of the foot at a young age can provoke the destruction of articular cartilage. This does not threaten human life, but its quality suffers greatly.

People at risk need to be aware of a disease such as a marching fracture and seek help when the first signs appear. It is very important to monitor the quality of shoes and try to purchase those models that provide the most physiological position. Beauty requires sacrifice, but these sacrifices must be reasonable!

Preventive actions

After treatment, in order to avoid relapses, the patient will need to adhere to the following rules:

in the near future, give up long walks over too long distances;
avoid standing for a long time;
exclude those sports that will have a strong impact on the lower limbs (for example, running);
wear only comfortable shoes, a flat platform should be excluded, shoes with a slight elevation and an internal soft pillow in the area of \u200b\u200bthe instep will be relevant;
at the end of the day, do relaxing foot baths;
systematically undergo a course of special massage.

The prognosis for a marching fracture of the foot is always favorable. With timely detection of the problem and prompt medical attention, the fastest possible cure can be achieved.

It is always worth remembering that it is impossible to go on a serious hiking trip, which involves heavy loads without prior preparation. Also, people who have suffered such an injury are advised to change the type of activity that is associated with standing on their feet, carrying weights or constant movement over long distances.

A march fracture is not a reason to forget about sports and, in general, about an active lifestyle, the main rule is that any physical activity should be moderate.

Oftentimes, we are the ones to blame for all our troubles. So it is with the march fracture. To minimize the risk of such an injury, it is recommended to abandon the constant wearing of high heels, which deform the foot and do not allow the bones to form normally and, at least sometimes, to play sports. And walking in the fresh air will not only strengthen the bones of your legs, but will also have a beneficial effect on the health of the whole organism.

Use only comfortable shoes;

With a passive lifestyle, try to exclude long periods of walking;

A marching fracture is one of the safest fractures in the human body. It has no serious consequences for the body, and it is treated quickly enough. The most unpleasant thing in this pathology is pain in the foot area, which will accompany a person throughout the healing and fusion of bones.

To avoid this, you must follow some rules, lead an active lifestyle and be able to distribute the load on the foot.

Marching foot is a pathology that develops with excessive load on the lower limbs. Also, this pathology has other names, for example, marching fracture, Deichlander's disease, or recruits' disease, since most often the pathology develops in them due to the fact that they are not used to daily forced marches.

The reasons

To date, several groups of people are known who are at risk of developing this pathology, and first of all, these are conscripts - recruits. In this case, uncomfortable shoes and excessive physical activity can become the causes, less often 3 and 4, and even less often - 1 and 5 metatarsal bones.

The second risk group includes professionals and tourism enthusiasts, especially women who like to travel in high heels. Such shoes are not designed for long transitions and can cause metatarsal fractures.

The third group are professional athletes who practice grueling workouts, often change the model of sports shoes or start strong loads without first warming up the muscles.

Also at risk are people of such professions as:

Hairdressers.
Sellers.
Bartenders.
Waiters.
Cooks.
Loaders.
Guides.
Models.
Couriers.

At the same time, a marching fracture of the foot is often diagnosed along with flat feet, unpreparedness of the body for stress and constant wearing of uncomfortable, worn or worn out shoes.

Clinical signs

The first and most important symptom of the disease is pain. In this case, the pain may be sharp or not very pronounced. In the first case, this will indicate an acute form, in the second - a chronic one. Pain in the acute form will appear only a few days after the overstrain, but the chronic one will increase and develop gradually.

The pain is felt in the middle of the foot and can sometimes be unbearable and very intense. As a result of this, a person tries to load the leg as little as possible, not to step on it, which affects the gait, lameness appears.

Of the other signs that can be attributed to the visible, first of all, it is necessary to note the swelling of the foot in the area of the metatarsus. At the same time, in the place where there is a pathology, the edema will be more dense. Also, in the affected area, increased sensitivity of the skin is noted, but changes in its color are a very rare phenomenon.

Patients need to know that a marching fracture of the foot is not characterized by other signs of fractures, or rather, their open forms, the presence of changes in the blood or elevated body temperature.

Diagnostics

Pain and swelling are the signs that require an urgent visit to a doctor, and this fracture is always closed and in some cases the characteristic lines of a broken bone can not be seen on the x-ray. Therefore, this method is rarely used in this case. It is best to use CT or MRI for diagnosis.

In some cases, palpation helps to identify the presence of a fracture, but this method cannot be considered reliable, and additional methods are also needed here to help see the entire clinical picture and determine the stage of the pathological process.

Conservative treatment

The treatment of the marching foot is usually conservative, as it is a closed fracture that has no displacement of the bones. The basic principles are long-term rest for the affected limb. Be sure to apply a plaster cast for about one month.

Treatments such as physiotherapy and topical administration may also be used to help relieve. After removing the plaster, a course of physiotherapy exercises and massage are prescribed. At this time, it is also necessary to do a control x-ray or MRI.

To prevent further injury, it is necessary to wear only orthopedic insoles for shoes, or individual orthopedic shoes.

Subject to all the rules of treatment, as well as wearing a plaster cast for a month, the fracture heals without any consequences, and after that the patient can return to the usual rhythm of life again. However, in the future, you need to make sure that there is no overload of the legs, wear only comfortable shoes and choose an acceptable training rhythm.