Stress fracture nonunion at the base of the fourth metatarsal associated with metatarsus adductus

a case report

Abstract

Fourth metatarsal (MT) stress fractures are uncommon injuries. Stress fractures of the base of the fourth MT have been described in literature in just a few reports. These patients’ injuries tended to take longer to heal than other lesser metatarsal fractures and stress fractures, which are typically more distal. Theodorou et al. in 1999 described seven cases of stress fractures of the fourth metatarsal. They correlated the injury with an adducted forefoot. Clinical improvement was shown to take up to 8 weeks. Saxena et al. in 2001 reported five case histories of athletic patients who sustained injuries at the proximal fourth metatarsal. All of them presented a trend to prolonged healing. Our patient case suggests that this stress fracture must be kept under careful observation to ensure adequate primary healing. Established nonunion, especially in young active patients, may require operative treatment.