TY - JOUR
T1 - Stress fractures of the lateral rays in the cavovarus foot
T2 - Indication for surgical intervention
AU - Bluth, Benjamin
AU - Eagan, Michael
AU - Otsuka, Norman Y.
PY - 2011/10
Y1 - 2011/10
N2 - Lateral ray stress fractures are a known complication of the cavovarus foot deformity. Malpositioning of the forefoot and hindfoot leads to increased pressure on the heel and lateral rays, resulting in significant morbidity. Patients with nonprogressive deformities can be managed surgically or nonsurgically in an attempt to decrease adverse events. It is often difficult to predict which patients will benefit most from a surgical intervention. This article describes 2 model cases of stress fractures in patients with nonprogressive cavovarus foot deformities. Patient 1 was an active patient with a minor, flexible cavovarus deformity, and patient 2 was a relatively inactive patient with a severe, fixed deformity. These cases serve to illustrate a spectrum of the 2 major risk factors for the development of a stress fracture of the lateral rays: severity of deformity and activity level of the patient. We believe the relationship between these 2 risk factors constitutes a threshold that allows the development of a stress fracture to serve as an adequate marker for surgical intervention. Within this patient population, a stress fracture indicates that given a patient's lifestyle, his or her deformity is sufficient enough to cause significant and repeated morbidity. Surgical restoration of the foot to plantigrade will eliminate the increased forces to the lateral metatarsals and decrease the incidence of further injury. Thus, stress fractures of the lateral rays in patients with nonprogressive cavovarus deformities should be considered an indication for surgical intervention.
AB - Lateral ray stress fractures are a known complication of the cavovarus foot deformity. Malpositioning of the forefoot and hindfoot leads to increased pressure on the heel and lateral rays, resulting in significant morbidity. Patients with nonprogressive deformities can be managed surgically or nonsurgically in an attempt to decrease adverse events. It is often difficult to predict which patients will benefit most from a surgical intervention. This article describes 2 model cases of stress fractures in patients with nonprogressive cavovarus foot deformities. Patient 1 was an active patient with a minor, flexible cavovarus deformity, and patient 2 was a relatively inactive patient with a severe, fixed deformity. These cases serve to illustrate a spectrum of the 2 major risk factors for the development of a stress fracture of the lateral rays: severity of deformity and activity level of the patient. We believe the relationship between these 2 risk factors constitutes a threshold that allows the development of a stress fracture to serve as an adequate marker for surgical intervention. Within this patient population, a stress fracture indicates that given a patient's lifestyle, his or her deformity is sufficient enough to cause significant and repeated morbidity. Surgical restoration of the foot to plantigrade will eliminate the increased forces to the lateral metatarsals and decrease the incidence of further injury. Thus, stress fractures of the lateral rays in patients with nonprogressive cavovarus deformities should be considered an indication for surgical intervention.
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U2 - 10.3928/01477447-20110826-28
DO - 10.3928/01477447-20110826-28
M3 - Article
C2 - 21956071
AN - SCOPUS:80053906752
SN - 0147-7447
VL - 34
SP - e696-e699
JO - Orthopedics
JF - Orthopedics
IS - 10
ER -