A radiolucent resorption gap can be seen around the fracture, which confirms the diagnosis. To confirm the diagnosis of stress fractures, the x-rays can be repeated after 10 to 14 days of the onset of symptoms. Acute stress fractures are usually not detected with a standard X-ray. To diagnose metatarsal overload, additional weight-bearing roentgenograms, including the lateral view of the foot and tangential view of metatarsal heads, are helpful. The radiographic evaluation consists of standard views of the foot, including anteroposterior, 45 degrees oblique, and lateral projection. Such injuries are usually seen in osteoporosis patients and postmenopausal women. Insufficiency fractures can also be seen in metatarsal bones, which occur due to normal stress loading over a weakened bone. The other variety of fractures that are commonly seen in metatarsal bones is stress fractures which result from a small amount of repetitive force and are commonly associated with ballet dancers, athletes and soldiers, hence termed “march fracture.” Multiple risk factors associated with stress fractures include hyper load syndrome, Morton’s foot, anorexia nervosa, amenorrhea, and prolonged hypoestrogenism. In the former mechanism, the metatarsal head remains fixed while body weight lies over the hindfoot, especially against the base of metatarsals. The common mechanisms of injury are either longitudinal compression of the foot or rotation around a fixed forefoot. The Lisfranc fracture-dislocation can result due to falling from height or stairs. The Lisfranc joint complex consists of the tarsometatarsal joints. Supination injuries to the foot may result in avulsion fractures of the fifth metatarsal base because of the tension generated over the peroneus brevis tendon and the lateral cord of plantar aponeurosis. Indirect trauma occurs when there is a twisting movement of the hindfoot and leg while the forefoot is fixed. Direct trauma can occur due to the fall of heavy objects on the foot and is usually seen in industrial workers. Such injuries may vary from a simple isolated metatarsal fracture to crush injuries involving multiple fractures and drastic soft tissue compromise. The most common etiology for metatarsal fractures is either direct or indirect trauma.
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