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Knöcherne Stressreaktionen des Fußes im Sport

Diagnose, Beurteilung und Therapie

Stress reactions in bones of the foot in sport

Diagnosis, assessment and therapy

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Zusammenfassung

Stressreaktionen und -frakturen werden als Strukturschäden des Knochens infolge von wiederholten oder stereotypen Beanspruchungen definiert. Die Balance zwischen Belastung und Entlastung des Knochens wird bei den Stressreaktionen und -frakturen durch die sportartspezifischen Beanspruchungen sowie durch vorliegende exogene bzw. endogene Risikofaktoren gestört. In der Sportorthopädie werden die Lokalisationen in „High-risk- „ und „Low-risk-Frakturen“ unterteilt. Die konventionelle radiologische Diagnostik kann zu Beginn dieser Verletzung negativ ausfallen. Bei persistierenden Beschwerden über 2 Wochen sollte eine weiterführende Diagnostik (Magnetresonanztomographie) durchgeführt werden. Im Bereich des Fußes können Stressreaktionen und -frakturen häufig bilateral oder multifokal auftreten. Am häufigsten betroffen ist das Metatarsale II gefolgt vom Metatarsale III, Metatarsale V, Metatarsale-II-Basis, Malleolus medialis. Sesambein und Naviculare sind High-risk-Frakturen, die eines besonderen klinischen und radiologischen Monitorings bedürfen. Prinzipiell ist eine konservative Therapie mittels des 2-Phasen-Modells die Therapie der Wahl. Bei „delayed union“ oder starker Schmerzhaftigkeit ist eine operative Versorgung indiziert.

Abstract

Stress reactions and stress fractures are defined as structural damage to bone caused by repetitive stress or stereotypical loading. The balance between loading and unloading of bone is disrupted in stress reactions and stress fractures through the sport-specific demands and by the exogenous or endogenous risk factors present. In sports orthopedics the localization of stress reactions and stress fractures are subdivided into high risk fractures and low risk fractures. Conventional diagnostic radiology can initially be inconclusive. With symptoms persisting over 2 weeks further diagnostics using magnetic resonance imaging (MRI) should be performed. In the area of the foot stress reactions and stress fractures can often occur bilaterally or multifocally and most commonly affect the second metatarsals followed by the third metatarsals. Fractures of the fifth metatarsal, second metatarsal base, medial malleolus as well as navicular and sesamoid fractures are high risk fractures requiring special clinical and radiological monitoring. Basically, conservative treatment using the 2-phase model is the treatment of choice. In delayed union or severe pain surgical treatment is indicated.

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  1. Docortho, Praxis für ganzheitliche Orthopädie & Unfallchirurgie, Friedrichstraße 94, 10117, Berlin, Deutschland

    O. Miltner

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Miltner, O. Knöcherne Stressreaktionen des Fußes im Sport. Unfallchirurg 116, 512–516 (2013). https://doi.org/10.1007/s00113-013-2373-6

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