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1. 1. Metatarsal march fracture is primarily an occupational disease of soldiers. 2. 2. The author believes that metatarsal march fractures are caused by fatigue of the peroneus longus and tibialis posticus muscles. 3. 3. March fractures are more properly termed fatigue fractures. There is no basis for the belief, as some authors have indicated, that metatarsal march fractures are due to spasm and overactivity of the interossei muscles. 4. 4. The presence of an atavistic foot as an etiological factor of metatarsal march fracture is greatly over-rated. 5. 5. All of the metatarsal march fractures in this series which were investigated occurred in soldiers with normal feet, or in cases of slight degree of pes planus and in cases of pes cavus. Not a single case of severe pes planus was encountered. 6. 6. Pre-induction occupation of the soldier does not appear to be a decisive element except insofar as the tolerance of fatigue may be concerned. 7. 7. The thinness of the metatarsal bone plays no important role in the etiology of metatarsal fractures as more fractures occurred in metatarsal bones other than the thinnest. 8. 8. All age groups from eighteen to thirty-eight were involved in metatarsal march fractures but the eighteen and nineteen year old group were chiefly affected. 9. 9. March fractures of the metatarsals involved all bones of the metatarsal segment but chiefly the second and third of the right foot. 10. 10. Twenty-three cases of multiple metatarsal march fractures were encountered. 11. 11. Fractures of the metatarsal bone involved 2.35 per cent of 10,953 cases seen by the Orthopedic Surgical Section at our Station Hospital.

1. 1. Six hundred and ninety two cases are reported with 724 march fractures. 2. 2. These patients were all treated by use of the steel bar countersunk in the slip sole of the shoe. 3. 3. Fifty-eight cases did not respond to the usual treatment; of this number thirteen were hospitalized and forty-five excused from certain portions of their training cycle. These fifty-eight trainees eventually finished training and were qualified for overseas. One man received a medical discharge. This was for an injured right knee and not for his march fracture. 4. 4. Two hundred thirteen thousand and twenty-four training hours were saved during fourteen months using the march bar treatment. 5. 5. Our series shows that most of the fractures occurred when the training cycle was stepped up in the fifth and sixth weeks of training. 6. 6. March fracture occurred more often in the right foot than the left. Any one of the metatarsal bones may be involved and one soldier can have two or three march fractures at the same time. 7. 7. The relative lengths of the first, third, and fourth metatarsal bones were measured in 692 cases of march fracture; the second metatarsal being used as a base and given the value of zero. The metatarsals of 100 normal feet were measured, and these measurements compared with the march fractured feet. There was no conclusive evidence of a relatively shortened first metatarsal playing a part in the etiological factor of march fractures.

1. 1. March or “fatigue” fracture is primarily an occupational disease associated with military training. 2. 2. Because of the insidious nature of the disease, many cases of march fracture are overlooked by the uninitiated. 3. 3. Etiology is obscure, but the author believes, as in cases of march fracture of the metatarsals, that it is due to muscle fatigue or muscle imbalance. 4. 4. March fractures occur in specific areas of predilection. 5. 5. X-ray appearance is that of an “ice crack” fracture. 6. 6. Displacement of fragments is unusual except in the case of fracture of the neck of the femur, where, if the fracture is not protected from weight bearing, coxa vara commonly occurs. 7. 7. March fractures, even if incomplete and not of striking x-ray appearance, must be treated with great respect, and too early weight bearing should be prohibited. 8. 8. Ideal treatment of march fractures of lower extremity and pelvis is bed rest and prohibition of early weight bearing. In fractures of the neck of the femur, immobilization is indicated. 9. 9. No case of delayed or non-union was encountered. 10. 10. In 10,953 orthopedic cases seen in a period of nine months at an Army Station Hospital, twelve cases of march fracture of lower extremity and pelvis, excluding metatarsal march fractures, were encountered. 11. 11. Case histories of six march fractures of the tibia, one of the fibula, two of the femur, and three of the pelvis were reported.

1. 1. One hundred forty-five cases of march fracture involving 142 patients were treated by hospitalization and immobilization of the injured extremity in a short-leg walking cast at the U. S. Army Hospital, Indiantown Gap Military Reservation. The injuries were incurred over a fifteen-month period, from May, 1951 until August, 1952, and include all patients treated at the hospital. 2. 2. There were 137 Caucasian and 5 Negro patients, with ages ranging from seventeen to thirty-one (average age, twenty-one). 3. 3. There were three readmissions for additional march fracture incurred from four to eight months later. 4. 4. The right foot was involved eighty-one times, the left sixty-seven. The third metatarsal was the most frequently injured, there being eighty fractures of this bone; there were fifty-five of the second metatarsal, with only ten of the fourth, and three of the fifth. There were no march fractures of the first metatarsal. Three patients had two fractures simultaneously. 5. 5. The incidence of march fractures reaches a peak around the tenth week of basic training, which corresponds to the periods of lengthy speed marches and vigorous mountain climbing.