Summary of replies-the 5th MT fracture orthosis

Summary of replies-the 5th MT fracture orthosis

Sun G. Chung

3/9/1999

Hello OandP-Lers,

Thank you for your replies about the 5th MT fractures orthosis. And Sorry for the delay.

The recommendations were as below.
    - Modified UCBL type with/without lateral covering over dorsum of forefoot.
    - Arizona Brace
    - Rigid function foot orthosis
    - Stiff soled walker boot with soft liner
    - Custom molded inner sole


Here are the replies.


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There was a brace introduced at the 66th annual meeting of American Academy
of Orthopaedic Surgeons, February the 5th in Anaheim, California. The
complete long study of the Arizona Brace is on the internet web site
<URL Redacted>
It was also introduced at 2nd Combined meeting of Foot and Ankle Surgeons in
Venice,
Italy in September 1998. I've heard of some really good reports, like 90%
success rate.
Check it out. It says it is also good for nonoperative treatment of
posterior tibial tendinitis.

(I copied this of the web site:)
1.Function:
    1.To stabilize ankle area, talocalcaneal, midtarsal, and subtalar joints.
    2.To create medial and lateral stability.
2.Conditions:
    1.Tibialis tendinitis (posterior/anterior).
    2.Ankle arthritis, and DJD (Degenerate Joint Disease. )
    3.Ankle, subtalar, or midtarsal trauma.
    4.Talocalcaneal varus or valgus.
    5.Severe pronation, pes planus.

Being a Certified Pedorthist & Orthotist I know the 5th MT stress fracture
is notorious for their nonunion, and can be a big problem. I would be
interested in your replies. Would you be good enough to compile the answers,
and send them over the Orthotics and Prosthetics List Service.
Thank You,
Charles L. Eral, Orthotist, C.Ped.
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We have used a modified UCB insert with lateral forefoot and hindfoot posts
with basketball players and havce been able to get them through the season.
bill barringer
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Any one of the many stiff soled walker boots will work. These usally
have a soft inner lining, some sort of rigid side support, terminate
above the ankle, have a fixed no motion ankle joint, and are able to
be removed for bathing and sleep.

Steve Strasburg
<Email Address Redacted>
Univ of Michigan Orthotics/Prosthetics Dept
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good custom molded innersole shouhld work to spread load out. If he wants
to play it can't be rigid.

Paul T Webber
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We use a foot orthotic that looks like a UCBL but only has the lateral flange and no medial flange. Another description: a plastic foot orthotic with the lateral edge trimmed to come up over about two inches of the forefoot . This has been used very successfully.

Don
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I know of no particular brace that helps heal 5th metatarsal fractures. I
agree with you that 5th base fractures are often difficult to heal because of
the pull of the peroneal tertius and brevis on the base. If it is a Jones
fracture then the prognosis is not good. I would suggest that if it is not
well healed that a-o fixation may be in order. If it really is healed I would
suggest that patient be placed in a rigid function foot orthotic device taken
with the patient's foot in neutral subtalar joint position with the midtarsal
joint locked. I would suggest a neutral suspension cast technique. I would
also make certain that the rear foot is not so unstable that the patient is
constantly experiencing supinatory forces that would result in a mechanical
stress to the lateral aspect of the foot.

Richard Stess, DPM
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I did have one such case of the 5th metatarsal fx on a teenage basketball player.
After the acute healing the Physcian requested a fx brace and immediately,
I made him a full legnth Orthoplast foot orthosis with an extended lateral flange which
covered the lateral dorsum. He did well with the orthosis, however we replaced it
with a Polyethelene design six months later.

I Hope this is helpful.

Rick Churchill, CO
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The Arizona Brace is a good orthosis for this condition if it is designed to
limit stress on the 5th metatarsal. It also may be overkill depending on
the patient. Stress can also be reduced by the use of a well designed FO
and rocker bottom shoes.

Incidentally, after having a DPM insist on my using an Arizona Brace for a
particular patient, I sent the cast off for them to fabricate one. What I
got back was simply an ankle lacer with reinforcement built in, not at all
unlike what we've made for many patients in house. I still don't know what
is special about this design.


        Harold Anderson, CO
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Thank you again!!!

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Sun G. Chung M.D., Ph.D.
Instructor
Dept Rehab Medicine
Seoul National University, College of Medicine
YeonGeon Dong 28, ChongRo Gu
Seoul Korea

<Email Address Redacted>
(T) 82-2-760-3954, 760-2619
(F) 82-2-743-7473
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