Marching stop

Marching stop disease Dahlander, March fracture) - traumatic tendonitis defeat II, rarely III metatarsal. Predisposing factor is flat. The emergence of the disease make for a long walk, wearing tight, uncomfortable shoes. Symptoms: in acute pain in the II - III metatarsal bones, especially when tenderness, swelling of the tissues of the back surface of the foot. Sometimes unbearable pains are character. In the chronic form (observed more often) patients complain of pain in the middle departments foot generated by the load, swelling of the rear foot. The diagnosis of marching feet specified radiographically. On radiographs defined area of cross enlightenment in diaphysis II or III metatarsal bone, sometimes peri-other overlay spindle-shaped form.
The prognosis is favorable. Disease duration 3-4 months.
Treatment depends on the form of the disease. In the acute form prescribed bed rest for 7-10 days, impose a plaster of Paris splint is placed with onmodelready vault. After acute nephritis phenomena, as well as chronic form prescribed thermal procedures (baths, paraffin baths), massage. For the prevention of relapse wearing shoes removable insoles, restriction walk. Cm. also Tendonitis.

Marching stop (synonym: March fracture, swelling of the feet, a broken recruits disease Dahlander, failure metatarsal bone, overloaded stop) - the most typical disease of the group of the so-called pathological rebuilding of bone. It usually develops in the second metatarsal bone, less often - in the third, rarer in IV or V, but not I. Defeat is usually solitary, but it is necessary to observe simultaneously or (more often) consecutive involvement of several metatarsal bones for one or on both feet. Marching stop occurs in healthy young soldiers typically, after a big jump. It contributes to the emergence of new, poorly fitting shoes. Predisposing factor is flat.
Flights often fall ill and stop athletes, moreover, not only men, but also women (often after the change of style shoes, excessive intensive gymnastic exercises without proper preliminary training); ill representatives of professions requiring prolonged walking, heavy lifting or standing (for example, medical personnel in operating).
Clinically there are two forms of marching feet: more frequent acute arising on 2 - 4th day after a big surge, and primary chronic, developing gradually. Without explicit traumatic stroke in the middle part of the foot, there are strong pain, unsteady gait and limp, lasting for weeks and months. On the back surface of the foot, over the diaphysis affected metatarsal bone is determined limited solid swelling and swelling of soft tissues. The skin is particularly sensitive, but only rarely blushes slightly. Never in patients with no common reactions of the whole organism: the body temperature, morphological and biochemical blood picture remain normal.
The nature of marching feet can be considered firmly established. This is not inflammatory or tumor process and a special kind of pathological restructuring, transformation of diaphyseal bone that develops under the influence of changed external mechanical and static-dynamic factors in the functional overload of the foot. Histologically in March foot found local lacunar resorption of bone tissue followed by its gradual replacement by new normal bone structures. Insolvent views on marching feet as a kind of gradually developing a fracture, or a hypothetical "broken transformation", or "microfractures". Thus, the old names of "marching fracture, fracture recruits" is incorrect and should be rejected.
Crucial to recognize the marching of the feet is the x-ray study. On a typical place in diaphysis metatarsal closer to the head, a current basis its (respectively the most functionally congested area) varies structural drawing of the damaged bone. All the diaphysis intersect transversely or slightly askew strip enlightenment width of several mm area of perestroika (see Looser zone of perestroika). The diaphysis metatarsal more or less like divided into two fragments, however, without offset against one another. Around the bones appear in parentheses periosteal expansion - first tender, sometimes longitudinally layered, in the future, it is very dense, reminiscent of the spindle-shaped bone spur (Fig). This periosteal clutch never apply to the epiphyses small tubular bones. Area enlightenment Looser sometimes captures and periosteal deposition on the surface of the bone. As the disease lozanovska area disappears, and the affected area of bone sklerosiruta. By this time the pain subside. The outcome of marching feet expressed in resolution periosteal layers, however, affected metatarsal bone forever remain structurally hardened and thickened.
The absence of marching feet in the history of acute single injury short and strong actions, the typical localization of the pathological process and save the main correct form of the diaphysis at the height of the disease without displacement of bone sections, separated perestroika, allow to distinguish this bright stripes from the line of the fracture. Rather characteristic clinical and x-ray picture enables us to exclude osteomyelitis, tuberculosis and other inflammatory processes and is especially true of the tumor.
At the beginning of the disease sometimes for not only of days, but a few weeks at convincing clinical manifestations marching feet x-ray picture of the foot may remain normal, and therefore should be a control x-rays, while the negative phase of radiology turns positive.
Forecast in March foot favorable. The total duration of the disease reaches 3-4 months.
Treatment of M. S. conservative. Surgical intervention is strictly contraindicated. Treatment is to eliminate the revealed during interrogation pathogenetic mechanism behind the emergence of M. S. (for example, a change of shoes), to the temporary discharge of the foot, calm, wearing disposable insoles, thermal and other physical therapy analgesic activities.

"March break" III metatarsal the soldier 25 years (5 weeks after start of infection).