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Bilateral fractures of the second metatarsals
  1. S Shyamsundar,
  2. A L Pimpalnerkar
  1. Department of Orthopaedics, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH 7 7DQ, UK
  1. Mr Shyamsundar

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Answers on p 805.

Case history

A 45 year old housewife presented with bilateral painful feet. The pain was located over the metatarsals and was increased by walking and decreased on rest. The initial x ray was normal and the patient was sent home with advice to rest. A provisional diagnosis of metatarsalgia was made. The patient was reviewed after two months with persistent symptoms and a severe antalgic gait;x rays (fig 1) of both   feet revealed callus around both second metatarsals, indicating healing fractures.

Figure 1

x Ray of feet showing healing metatarsal fractures.

Questions

(1)
What type of fractures are these and what is their aetiology?
(2)
Where are the other sites in the foot that stress fractures can occur?
(3)
What would be the best management at this stage?

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