What is the treatment for a dance fracture?

Treatment of a Dance Fracture

The treatment for a dance fracture (spiral fracture of the fifth metatarsal) is primarily conservative management with appropriate immobilization, as most cases heal well without surgical intervention. 1

What is a Dance Fracture?

• A dance fracture is a spiral or oblique fracture of the diaphysis (shaft) of the fifth metatarsal bone in the foot 1
• It's commonly seen in dancers and athletes but also occurs in the general population, particularly in women over 40 years of age 1
• Also known as a "dancer's fracture," it accounts for approximately 25% of all fifth metatarsal fractures 1

Diagnosis

• Initial evaluation should include X-rays of the affected foot to confirm the diagnosis 2
• If X-rays are negative but clinical suspicion remains high, MRI without contrast is recommended as a complementary study 2
• MRI has higher sensitivity for detecting stress fractures that may not be visible on initial radiographs 2

Treatment Algorithm

Initial Management

1. Immobilization:

   • Cast immobilization or protective boot is the first-line treatment 2, 1
   • A walker boot or stiff-soled shoe can be used for immobilization 1

2. Pain Management:

   • Appropriate analgesics for pain control 2
   • Application of ice to reduce swelling 2

3. Weight-bearing Status:

   • Limited weight-bearing initially, progressing as tolerated based on pain 2
   • No correlation has been found between the type of immobilization (walker boot vs. stiff-soled shoe) and healing time 1

Monitoring and Follow-up

• Regular follow-up with X-rays to assess healing progression 2
• Approximately 1 in 3 patients will require longer than 6 weeks for complete healing 1
• Return to dance activities should be gradual and only after clinical and radiographic evidence of healing 3

Special Considerations

For Dancers

• Mental practice techniques can help maintain dance technical capabilities during recovery 4
• Cross-training education should be implemented to decrease injury rates when returning to dance after prolonged time off 5
• Dancers should never be advised to stop dancing completely, as this can have significant psychological impacts 4

For Older Adults (40+ years)

• Dance fractures in individuals over 40 years should be treated as potential fragility fractures 1
• Consider evaluation for osteoporosis or osteopenia, as 80% of dance fractures in the general population occur in women over 40 years 1
• In older adults, these fractures typically result from low-energy trauma mechanisms 1

Prevention Strategies

• Pre-semester screening for dancers to identify risk factors 5
• Education on proper technique and footwear 4
• Attention to training schedules, as dancing more than 5 hours per day significantly increases stress fracture risk 3
• For female dancers, monitoring menstrual health is important as prolonged amenorrhea is associated with increased stress fracture risk 3

Complications and Pitfalls

• Delayed union or non-union may occur, particularly in cases with poor compliance with weight-bearing restrictions 1
• Dancers often underreport injuries and attempt to continue dancing despite pain, which can worsen outcomes 6
• Assessment periods in dance schools/companies show higher injury rates, suggesting that performance pressure may contribute to injury risk 6

When to Consider Surgical Management

• Surgery is rarely needed for uncomplicated dance fractures 2
• Consider surgical consultation for:
  • Displaced fractures with significant deformity 2
  • Non-union after appropriate conservative management 2
  • Elite dancers or athletes who require faster return to high-level performance (though evidence for faster recovery with surgery is limited) 2

By following this treatment approach, most dance fractures heal successfully with conservative management, allowing for return to full activities including dance.