Abstract
The goal of this study was to evaluate the effects of maintaining different foot postures
during healing of proximal fifth metatarsal fractures for each of 3 common fracture
types. A 3-dimensional (3D) finite element model of a human foot was developed and
3 loading situations were evaluated, including the following: (1) normal weightbearing,
(2) standing with the affected foot in dorsiflexion at the ankle, and (3) standing
with the affected foot in eversion. Three different stages of the fracture-healing
process were studied, including: stage 1, wherein the material interposed between
the fractured edges was the initial connective tissue; stage 2, wherein connective
tissue had been replaced by soft callus; and stage 3, wherein soft callus was replaced
by mature bone. Thus, 30 3D finite element models were analyzed that took into account
fracture type, foot posture, and healing stage. Different foot postures did not statistically
significantly affect the peak-developed strains on the fracture site. When the fractured
foot was everted or dorsiflexed, it developed a slightly higher strain within the
fracture than when it was in the normal weightbearing position. In Jones fractures,
eversion of the foot caused further torsional strain and we believe that this position
should be avoided during foot immobilization during the treatment of fifth metatarsal
base fractures. Tuberosity avulsion fractures and Jones fractures seem to be biomechanically
stable fractures, as compared with shaft fractures. Our understanding of the literature
and experience indicate that current clinical observations and standard therapeutic
options are in accordance with the results that we observed in this investigation,
with the exception of Jones fractures.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 17, 2012
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
