Marching stop – this is a pathological change in the structure of the metatarsal bones, which occurs due to excessive loads. It develops in soldiers, especially at the beginning of service, as well as after intensive drill, marches and cross-country runs. It can occur in people whose profession requires constant standing on their feet, carrying heavy loads, or walking for a long time. Predisposing factors are flat feet and wearing uncomfortable tight shoes. It is manifested by pain in the foot, sometimes – sharp, unbearable. The pain increases with exertion and is accompanied by local edema of the foot. The diagnosis is confirmed radiographically. Treatment is conservative, the prognosis is favorable.
Marching foot (rookie’s disease, marching fracture, Deutschlander’s disease) – a disease caused by pathological restructuring of the metatarsal bones due to excessive stress. It can occur acutely or chronically, but more often it has a primary-chronic course. It is treated conservatively, performed by specialists in the field of traumatology and orthopedics, and ends with a full recovery.
Marching foot is observed in soldiers, athletes and people whose profession is associated with prolonged walking, standing or carrying heavy loads. The likelihood of development increases when using uncomfortable shoes and flat feet. According to studies conducted in different countries, people with a low level of habitual physical activity are more likely to develop a marching foot after intense exercise. It is believed that this is due to lower bone strength. It is no coincidence that another category of such patients today is increasingly becoming tourists-office workers who actively “run” around tourist attractions in uncomfortable shoes during the holiday period.
In Deichlander’s disease, changes occur in the middle (diaphyseal) part of the metatarsal bones. The pathological rearrangement of bone tissue in this case is caused by changed mechanical and static-dynamic factors. The second metatarsal bone is most often involved in the process, less often – III, even less often-IV and V. This distribution is due to the peculiarities of the load on the foot when standing and walking, since in such cases the inner and middle parts of the foot are more “loaded”. I metatarsal bone is never affected. This is probably due to its higher density and strength.
Usually only one bone is affected, although both simultaneous and consecutive damage to several bones on one or both feet is possible. It has been established that the marching foot is a special type of bone tissue transformation that is not associated with a tumor or inflammation.
At the same time, experts ‘ views on the nature of damage are still divided. Some believe that the reconstruction of the bone is accompanied by an incomplete fracture or the so-called “microfracture”. Others believe that the term “marching fracture” should be considered outdated and does not correspond to reality, since there is only local resorption of bone tissue, which is subsequently replaced by normal bone without the formation of a bone callus.
Symptoms of marching foot
There are two clinical forms of the disease: acute and primary-chronic. The first one is observed less often, develops on 2-4 days after a significant overexertion (for example, a long march). The second arises gradually, gradually. Its symptoms are less pronounced. There is no history of acute marching foot injury. Patients with this diagnosis complain of intense, sometimes unbearable pain in the middle part of the foot.
A limp appears if the gait becomes uncertain, patients try to spare the injured limb. On examination, local edema is detected over the middle metatarsal bone and a denser swelling in the affected area. Skin sensitivity in this area increases. Hyperemia (redness of the skin) is quite rare and never pronounced. Patients also never show general symptoms: there is no increase in body temperature, no change in the biochemical or morphological picture of the blood. The pain may persist for several weeks or even months. The average duration of the disease is 3-4 months. The disease ends with a full recovery.
The diagnosis is made based on a survey, examination, and X-ray data.. The picture obtained during the X-ray examination is crucial. In Deichlander’s disease, a change in the structural pattern is detected in the area of the diaphysis of the affected metatarsal bone (sometimes closer to the head, sometimes to the base, depending on the location of the most functionally congested area). An oblique or transverse band of enlightenment (Loozer’s enlightenment zone) is determined – the area of bone rearrangement. It looks as if the metatarsal bone is divided into two fragments. However, unlike the X-ray picture of a fracture, there is no displacement in this case.
Subsequently, periosteal growths occur around the affected part of the bone. At first, they are thin and tender, then dense, similar to a fusiform callus. Later, the zone of enlightenment disappears, sclerosis occurs. Over time, the periosteal layers resolve. In this case, the bone remains permanently thickened and compacted. The defining features are the absence of acute trauma, the typical localization of the injury, and the presence of a reconstruction zone in the absence of displacement of fragments and maintaining the correct shape of the bone. It should be noted that during the first few days or weeks, radiological signs of the disease may be absent. Therefore, with characteristic symptoms, it is sometimes necessary to perform several radiographs with a certain time interval.
Marching foot treatment
Traumatologists are engaged in therapy. Treatment is strictly conservative, surgical interventions are contraindicated. In acute form, the patient is put on a plaster splint and prescribed bed rest for a period of 7-10 days. After the acute manifestations of the disease subside, as well as in the primary chronic form of the disease , massage and heat (paraffin applications, baths) and other physiotherapy procedures are prescribed. In the future, patients are recommended to use insole inserts and avoid long walks.
Prognosis and prevention
The prognosis is favorable, with the elimination of stress and adequate conservative therapy, all symptoms disappear within 3-4 months. Prevention consists of choosing comfortable shoes, choosing reasonable physical activities, and careful medical supervision of new soldiers.