Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
PM R. 2021 Nov;13(11):1281-1290. doi: 10.1002/pmrj.12518. Epub 2021 Jan 4.
Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
跖骨骨应力性损伤（BSI）在运动人群中很常见。BSI 是一种过度使用损伤，是由于微损伤的积累超过了骨重塑的能力。跖骨 BSI 的风险是多因素的，包括与解剖、生物学和生物力学相关的因素。在本文中，讨论了影响足部对负荷反应的解剖因素，包括足型、跖骨长度、骨密度、骨几何形状和内在肌肉力量。生物因素，如低能量可用性和骨代谢受损，会影响骨的质量。最后，还回顾了对骨骼的生物力学负荷的影响，如峰值力、负荷率和加载循环。讨论了跖骨 BSI 的一般管理，包括急性护理、康复、难治性跖骨 BSI 的治疗以及愈合/重返运动的评估。最后，我们确定了跖骨 BSI 的未来研究重点和新兴治疗方法。
