Case reportWalking Gait Before and After Chiropractic Care Following Fifth Metatarsal Fractures: A Single Case Kinetic and Kinematic Study
Introduction
Foot injuries and alterations in walking gait are some of the concerns brought to chiropractors. The fifth metatarsal is among the more commonly fractured bones of the foot, often either as avulsion or Jones fractures.1, 2, 3 Jones fracture occurs at the metaphyseal–diaphyseal junction of the fifth metatarsal, an area with a low blood supply that is prone to prolonged healing or nonunion. Other types can occur in the head, neck, and mid-shaft. 1, 2, 3, 4, 5 Younger patients with metatarsal fractures are more often male, but older patients are more often female.6
Associated signs and symptoms include pain, swelling, tenderness, difficulty walking, and bruising. There is considerable variation in management, especially if a Jones fracture is suspected.1, 3, 4, 7, 8, 9, 10, 11, 12 Since 1984, Torg et al’s13 recommendation of conservative treatment for Jones fractures, with a non-weight bearing cast for a period of 3 to 12 weeks, has been frequently followed.5, 10, 12 In 2017, Brogan et al14 concluded that all fifth metatarsal fractures can be safely managed with immediate full weight-bearing in an orthotic boot without adverse effects and that often no long-term review is needed. Most experts agree, however, that if the injury involves a displaced bone, multiple breaks, or fails to adequately heal, then surgery may be needed.1, 2, 3, 5, 12, 15
Metatarsal fractures might result in alterations of walking. Bauer et al16 reported gait asymmetry in 11 out of 20 patients with fifth metatarsal fractures, most with no visible gait disorder. Kösters et al17 reported slower walking associated with multiple metatarsal shaft fractures. Queen et al18 found that women with a history of metatarsal stress fractures exhibit decreased forefoot forces.
Chiropractic literature describes management of foot and ankle conditions.19, 20, 21, 22, 23, 24, 25 However, only 1 chiropractic publication concerns fifth metatarsal fracture, which is only in terms of diagnostic imaging, not condition management.26 The purpose of this report is to describe the kinetic and kinematic investigation of post-injury walking gait of a patient, before and after receiving chiropractic care.
Section snippets
Patient Characteristics
A 62-year-old female presented to the research center with concerns that recent injuries of her left foot had not fully resolved and reported abnormal gait, due to pain and several weeks use of a “walking boot.” Acute inversion injury and Jones fractures of the proximal fifth metatarsal had occurred twice within 6 months. For both fractures, she received conservative treatment with non-weight-bearing casts for periods of several weeks. At 10 weeks from the onset of the second injury, she was
Discussion
Several findings document the participant’s improvements in walking, from pre-care to the post-1 and post-2 assessments. Considering that her main reason for seeking care was a distinctly asymmetrical problem, it’s important to note the greater symmetry seen in the post-1 and post-2 assessments for hip flexion and extension, loading and pre-swing periods during stance phase, and timing of the peak 1 and peak 2 force events.
The participant’s increased self-selected walking speed in itself
Conclusions
The patient in this case recovered completely, and the post-injury kinematic and kinetic data allowed for quantification of gait patterns and changes that, in many clinical environments, could only be judged more subjectively.
Acknowledgments
The authors thank Michael T. Weiner, DC, for data collection and review of this manuscript.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
Contributorship Information
Concept development (provided idea for the research): K.T.H.
Design (planned the methods to generate the results): B.S.R., K.T.H., R.S.H.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): B.S.R., K.T.H.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): B.S.R., R.S.H.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results):
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