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The availability of x-ray examination to the large number of individuals in the Armed Services has brought to light many minimal injuries which tend to be ignored or overlooked in a comparable civilian population, while the rigors of training have increased the incidence of such injuries. There have been many reports on march fractures of the metatarsals observed during training periods and following marches. To the metatarsal fracture have been added march fracture of the femoral neck (1), march fracture of the femur (2), of the tibia (3), of the fibula (4), and even march fracture of the pelvis (5). These fractures have been called, also, insufficiency fractures and fatigue fractures. They are not new. The march fracture of the metatarsal has long been known. It was noted among recruits in the French army, where it was called pes marches. It was frequent, also, among the German troops, especially after practising the “goose-step” of the old Imperial Army, being known as Fussgeschwulst. Insufficiency fra...

The aim of the present study was the assessment of metatarsal head loading in combat boots of the German armed forces. With respect to the prevention of metatarsal stress fractures, we evaluated how cushioning insoles (made of EVA foam or neoprene) achieved a load reduction in comparison with conventional insoles.Local pressure, force and impulse values were determined with the pedar-m expert in-shoe pressure measurement system applied in 26 volunteers during walking with four different insoles made of synthetic mesh, EVA foam and neoprene. Data analysis was performed with SAS and tested for statistical differences with non-parametric tests (with p0.05 as a significance level).For the peak pressures under the metatarsal heads (MT) the following order was found: MT-IIMT-IIIMT-IMT-IVMT-V. A comparison of the insoles indicated that the neoprene insole resulted in the lowest peak pressures with significant load reductions under MT-III to MT-V (p0.00001). Furthermore, the impulse values under MT-II to MT-V were significantly lower with neoprene insoles (p0.0002). However, the subjects rated the conventional insoles as more comfortable and better fitting than the newly developed insoles.The cushioning insoles were superior to the conventional insoles with respect to the plantar pressure distribution. With respect to the load reduction we can conclude that the modified insoles might be able to reduce the incidence of march fractures. The biomechanical advantage does not appear to be related to personal preferences.

Several reports have been published on “march” fracture of the tibia (3, 7, 8, 12, 14, 15, 16), but dealing usually isolated cases or small series. The same type of fracture of the metatarsals has been discussed in numerous publications (1, 4, 5, 6, 9, 10, 11, 13, 17), especially during World War II, with several large series of cases being presented. Having failed initially to recognize the first case of march fracture of the tibia encountered, and having seen 14 additional cases in a relatively short period of time, the author considered it appropriate again to call attention to this lesion, which is seldom seen in civilian life but is found with considerable frequency at any Army camp where a large number of recruits are undergoing strenuous military training. The tibia is second only to the metatarsals as the most common site of occurrence of this type of fracture. Krause (12), in reporting 4 cases observed among soldiers in active training, states that the most common location of the fracture is on t...

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.

FATIGUE fracture, synonymously called march fracture, is a condition most commonly seen in recruits who are suddenly subjected to unaccustomed physical training. This entity was initially recorded by Briethaupt in 1855, and was overlooked in this country until 1939, when Roberts and Vogt1 described 12 so-called pseudofractures of the tibia. Since then, description of this condition has been generally limited to the European literature, and great interest was quickened in the early 1940's.2 3 4 From December, 1955, to May, 1958, inclusive, a total of 97 fatigue fractures of the pelvis and the lower extremity in 83 patients were observed at the . . .

The diagnosis of march fracture of the inferior pubic arch should be considered whenever there is a history of unusual physical stress associated with complaints of pain in the perineum; roentgenographic evidence of a break in the continuity of the inferior pubic ramus and calcification about the site confirm the diagnosis.

"March foot" or "march fracture" is a term applied to a painful condition of the foot first noted in army men following prolonged marches. It was thought to be caused originally by an inflammation of the tendon sheaths, but since the turn of the century opinion has favored the existence of a fracture. Some reports hold that a fracture visible or invisible by x-rays is present from the start. Others speak of a periostitis first, followed by a fracture line developing later. For the most part this condition has been noted in the second, third and fourth metatarsal bones, but the more recent literature has been reporting a few cases of a similar condition occurring in other bones, especially the fibula. Our purpose in this paper is to add 6 such cases and 1 of the foot appearing in athletes at Princeton University. The University Health Service has maintained medical