Clinical outcome of screw fixation for stress fractures at the base of the second metatarsal in ballet dancers: A retrospective case series.

Authors

Tomohiro Matsui, Takeshi Sugimoto, Hideaki Nagamoto, Tsukasa Kumai

Published in

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. Aug 04, 2026. Epub Aug 04, 2026.

Abstract

Stress fractures at the base of the second metatarsal are characteristic overuse injuries in ballet dancers, caused by repetitive forefoot loading during pointe work. Conservative treatment may sometimes result in delayed healing or recurrence in a subset of patients.
We retrospectively reviewed five female ballet dancers with second metatarsal base stress fractures unresponsive to at least 3 months of conservative care, defined as persistent pain with no CT evidence of bone union despite activity restriction and off-loading. All underwent fixation with two Headless Cannulated Screw (HCS) via a dorsal mini-open approach, without immobilization. Outcomes included radiographic union confirmed by CT, time to resumption of pointe work, jumps, and return to preinjury activity level, as well as functional recovery assessed with the JSSF midfoot scale. CT-based union was independently assessed by two observers.
All dancers achieved radiographic union within 11 weeks (mean, 7.0 ± 3.4 weeks; median, 6; IQR, 5-10). There was complete agreement between observers (100% agreement; ICC, 1.0 [95% CI, 1.0-1.0]). FWB occurred at a mean of 4.4 ± 3.0 weeks (median, 3; IQR, 3-6). Pointe work resumed at a mean of 7.4 ± 3.2 weeks (median, 6; IQR, 6-8), and jumping at 8.8 ± 3.3 weeks (median, 8; IQR, 7-9). Return to preinjury activity level occurred at a mean of 13.8 ± 5.0 weeks (median, 12; IQR, 10-17). The mean JSSF midfoot score improved from 77.8 ± 5.4 preoperatively to 98.0 ± 4.5 postoperatively. No recurrences or implant failures were observed at a mean 5-year follow-up. One patient experienced transient postoperative foot numbness that resolved within 3 months.
These preliminary observations suggest that this technique may be considered a potential option requiring further comparative evaluation for selected patients at risk of delayed union or recurrence. However, spontaneous progression toward union cannot be excluded, and treatment efficacy cannot be established without a comparison group.
Level Ⅳ, Case series.

PMID:
42552186
Bibliographic data and abstract were imported from PubMed on 05 Aug 2026.

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