Sunday, June 16, 2024
Forefoot Injuries INJURIES

Dancer’s Fracture: Causes, Symptoms, Diagnosis & Treatment

Dancers put a lot of strain on their feet, which can make them vulnerable to a variety of injuries, especially in the forefoot area. One type of injury that is particularly common among dancers is a “Dancer’s Fracture,” which refers to a fracture that occurs in the body of the fifth metatarsal bone.

Dancer’s fractures occur due to repetitive stress on the bone or from a traumatic event. Repetitive stress can occur during activities such as jumping, landing, or sudden changes in direction. Trauma occurs from direct impact or a twisting motion of the foot.

In this article, we’ll discuss the causes, symptoms, diagnosis, and treatment of Dancer’s Fractures. 

Anatomy of the Fifth Metatarsal

The fifth metatarsal bone is one of the five long bones in the foot. It is located on the outside of the foot and is connected to the pinky toe. 

It has three main parts: the base, shaft, and head. 

The base (on the bottom of the fifth metatarsal) is the widest part of the bone. 

The shaft is the long middle portion of the bone, while the head is the rounded end that connects to the toe. 

A Dancer’s fracture is when there is a fracture in the shaft (middle part) of the fifth metatarsal bone.  

Fifth metatarsal Dancer’s fractures make up 20% of all fifth metatarsal fractures (1).

Causes of Dancer’s Fractures

A Dancer’s Fracture happens due to a specific mechanism. Landing on the foot when the foot is pointing downwards (plantar-flexion), can cause a rotational force, resulting in a spiral or oblique fracture at the fifth metatarsal.  

For example, let’s say a ballet dancer is performing a series of jumps that involve repeatedly landing on the ball of their foot with the foot pointed downwards (plantar flexion). 

If the dancer’s foot lands awkwardly or they twist their foot during the landing, the resulting forces from the ground can cause a Dancer’s Fracture in the fifth metatarsal bone.

Dancer’s Stress Fractures

In addition to trauma or sudden impact, Dancer’s Fractures can also occur due to repetitive stress on the fifth metatarsal bone. This results in a Dancer’s stress fracture. 

Stress fractures are common in dancers who regularly engage in activities that put a lot of stress on their feet, such as jumping, landing, and sudden changes in direction. Over time, repeated stress can cause microfractures in the bone.  

Symptoms 

A Dancer’s Fracture can cause a variety of symptoms, depending on the severity of the fracture.  

In general, the most common symptoms of a Dancer’s Fracture include pain, swelling, and difficulty bearing weight on the foot. 

Other symptoms include:

  • Bruising
  • Numbness and tingling in the outer foot
  • Difficulty walking or standing
  • Pain that is relieved with rest
  • Stiffness or limited range of motion in the foot and ankle

It’s important to seek medical attention from a foot doctor if you experience any of these symptoms.

xray dancer's fracture

Diagnosis

Diagnosing Dancer’s Fractures involves a combination of physical examination and imaging tests. 

During the physical exam, your doctor will obtain a medical history and conduct a thorough examination of your foot and ankle. 

He/she will press on the foot to check for tenderness in the fifth metatarsal.

Foot x-rays will be ordered to visualize the fracture line position and severity of the fracture. Your doctor will be checking to see whether the fracture is nondisplaced or displaced.

nondisplaced fracture means that the fracture fragments are still in their proper alignment, while a displaced fracture means that the fragments have moved out of alignment. 

In some cases, displaced fractures will require surgery to ensure proper healing. 

Treatment

Dancer’s fractures are treated with immobilization and protected weight bearing. 

You will need to remain minimal weight-bearing in a cast boot for 6-8 weeks. 

Your doctor will obtain x-rays in their office every 3-4 weeks to assess for fracture healing. 

Full healing may take up to 3 months.

You will need to start RICE therapy.

RICE stands for Rest, Ice, Compression, and Elevation, and is a commonly used approach for managing acute injuries such as fractures.

Rest involves avoiding activities that put stress on the foot, such as jumping or running. This allows the bone to heal without further damage.

Ice can help reduce pain and swelling. You can apply ice to the affected area for 15-20 minutes at a time, three times a day. 

Compression involves using a bandage to apply pressure to the affected area. You can use an ACE bandage to wrap the foot. This will help reduce swelling. 

Elevation involves raising the affected foot above heart level, which can help reduce swelling and pain. 

When Is Surgery Needed?

If the fracture is severely out of alignment, or the fracture fragments are angulated, surgery may be warranted to prevent pain and deformity. This is especially true in competitive athletes who require a faster return to activity. 

Surgical repair would be done in the operating room under IV sedation or general anesthesia. 

The surgery would be performed by a Podiatrist or Orthopedic surgeon. 

The surgeon will repair the fracture and use screws and plates to hold the fracture in place. The surgery will take 1-2 hours to complete. 

Afterward, you will need to remain partial weight bearing to the foot in a cast boot for 4-6 weeks until the fracture heals. 

Physical Therapy 

Physical therapy is an important part of the recovery process. This is because immobilization after a fracture can cause your leg and foot muscles to become weak. You may also struggle with balance issues. 

Your doctor will suggest physical therapy be completed three times a week for one month. Repeat exercise will be needed. 

Your physical therapist will work with you to develop an individualized treatment plan that will include exercises to improve strength, flexibility, and range of motion in the foot and ankle. 

Scheduled exercise times will be needed throughout the day to help promote proper healing and prevent stiffness or weakness in the foot. 

How Is a Dancer’s Fracture Different From a Jones Fracture and an Avulsion Fracture?

A Dancer’s Fracture, Jones Fracture, and Avulsion fractures all occur in the fifth metatarsal bone. However, the location of each fracture and the severity vary. 

As stated previously, a Dancer’s fracture is a fracture that occurs in the body of the fifth metatarsal bone.  

A Jones metatarsal fracture, on the other hand, occurs at the metatarsal base, in a specific location known as the metaphyseal-diaphyseal junction. Both fractures can be painful. However, Jones fractures, in particular, are considered to be more serious due to their location and potential for complications such as delayed healing or nonunion. 

This is because the blood supply in the area where a Jones Fracture occurs is poor. This delays fracture healing. 

An avulsion fracture of the fifth metatarsal bone occurs from twisting injuries and rolling of the ankle. This causes the tendons and ligaments around the fifth metatarsal bone to pull on the bone, causing a small piece of bone to avulse away. Hence the term “avulsion fracture.”  

Patient Education

Patient education is an important aspect of the care and management of a Dancers Fracture. During their appointments, the health care provider will provide guidance on activity modification, including restrictions on certain activities that may aggravate the injury or delay healing. 

Patient education also includes advice on self-care techniques, such as ice and elevation, to help relieve pain and swelling. Proper management and care of Dancer’s Fractures through patient education are key to achieving the best possible outcomes for health.

Make an appointment with your Podiatrist or Orthopedic surgeon if you suspect that you have a Dancer’s Fracture. 

Related article: Foot Compartment Syndrome- Causes & Treatment of Compartment Syndrome in the Foot

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References

  1. Grigorios Kastanis., et al. “Functional Outcomes of Surgical Treatment of the Fifth Diaphyseal Metatarsal Fractures (Dancer’s Fractures). A Case-Series and a Literature Review”. Acta Scientific Orthopaedics 4.9 (2021): 09-15. https://actascientific.com/ASOR/pdf/ASOR-04-0352.pdf
  2. de Ruijter MA, Yuan JZ, Derksen RJ. The Clinical Outcomes of Operative Treatment Versus Conservative Treatment for Dancer’s Fractures: Protocol for a Retrospective Cohort Study. JMIR Res Protoc. 2022 Apr 5;11(4):e37171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9019637/
  3. Schwagten K, Gill J, Thorisdottir V. Epidemiology of dancers fracture. Foot Ankle Surg. 2021 Aug;27(6):677-680. doi: 10.1016/j.fas.2020.09.001. Epub 2020 Oct 21.https://pubmed.ncbi.nlm.nih.gov/33229215/

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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