Fractura del pie - Fractura de los huesos propios del pie

Urgencia media
Común-

Roturas o grietas producidas en alguno de los huesos que componen el pie. Incluye fracturas de los dos huesos pequeños y redondos que están justo debajo del dedo gordo (huesos Sesamoideos), de los huesos del tercio medio del pie (huesos metatarsianos), o de los huesos situados en la parte posterior del pie, como el hueso Calcáneo del talón.

Se produce por un traumatismo directo, caídas, torceduras o por sobrecarga repetitiva en el hueso.  Practicar deportes de impacto, utilizar equipo deportivo inadecuado o tener osteoporosis, aumentan el riesgo de padecerla.

Se manifiesta con dolor, hinchazón, hematoma y/o deformidad del pie.

Se diagnostica mediante exploración física y la realización de una prueba de imagen.

El tratamiento se basa en controlar el dolor y permitir se se recupere el hueso utilizando analgesia convencional y evitando cargar peso sobre el pie; casos más severos pueden necesitar cirugía. 

Para prevenir las fracturas es aconsejable usar calzado adecuado, realizar una dieta rica en calcio y vitamina D y evitar traumatismos en la medida de lo posible.

Referencias bibliográficas
  1. Warden SJ, Burr DB, Brukner PD. Stress fractures: pathophysiology, epidemiology, and risk factors. Curr Osteoporos Rep 2006; 4:103.
  2. Miller T, Kaeding CC, Flanigan D. The classification systems of stress fractures: a systematic review. Phys Sportsmed 2011; 39:93.
  3. Waterman BR, Gun B, Bader JO, et al. Epidemiology of Lower Extremity Stress Fractures in the United States Military. Mil Med 2016; 181:1308.
  4. Rizzone KH, Ackerman KE, Roos KG, et al. The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004-2005 Through 2013-2014 Academic Years. J Athl Train 2017; 52:966.
  5. Changstrom BG, Brou L, Khodaee M, et al. Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013. Am J Sports Med 2015; 43:26.
  6. Kelsey JL, Bachrach LK, Procter-Gray E, et al. Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc 2007; 39:1457.
  7. Tenforde AS, Sayres LC, McCurdy ML, et al. Identifying sex-specific risk factors for stress fractures in adolescent runners. Med Sci Sports Exerc 2013; 45:1843.
  8. Wright AA, Taylor JB, Ford KR, et al. Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med 2015; 49:1517.
  9. Zhao L, Chang Q, Huang T, Huang C. Prospective cohort study of the risk factors for stress fractures in Chinese male infantry recruits. J Int Med Res 2016; 44:787.
  10. Barrack MT, Gibbs JC, De Souza MJ, et al. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med 2014; 42:949.
  11. Krauss MR, Garvin NU, Boivin MR, Cowan DN. Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees. Am J Sports Med 2017; 45:311.
  12. Rauh MJ, Macera CA, Trone DW, et al. Epidemiology of stress fracture and lower-extremity overuse injury in female recruits. Med Sci Sports Exerc 2006; 38:1571.
  13. Mattila VM, Niva M, Kiuru M, Pihlajamäki H. Risk factors for bone stress injuries: a follow-up study of 102,515 person-years. Med Sci Sports Exerc 2007; 39:1061.
  14. Vinther A, Kanstrup IL, Christiansen E, et al. Exercise-induced rib stress fractures: potential risk factors related to thoracic muscle co-contraction and movement pattern. Scand J Med Sci Sports 2006; 16:188.
  15. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc 2013; 21:556.
  16. Pihlajamäki H, Parviainen M, Kyröläinen H, et al. Regular physical exercise before entering military service may protect young adult men from fatigue fractures. BMC Musculoskelet Disord 2019; 20:126.
  17. Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PM R 2010; 2:945.
  18. Dao D, Sodhi S, Tabasinejad R, et al. Serum 25-Hydroxyvitamin D Levels and Stress Fractures in Military Personnel: A Systematic Review and Meta-analysis. Am J Sports Med 2015; 43:2064.
  19. Burgi AA, Gorham ED, Garland CF, et al. High serum 25-hydroxyvitamin D is associated with a low incidence of stress fractures. J Bone Miner Res 2011; 26:2371.
  20. McClellan JW 3rd, Vernon BA, White MA, et al. Should 25-hydroxyvitamin D and bone density using DXA be tested in adolescents with lumbar stress fractures of the pars interarticularis? J Spinal Disord Tech 2012; 25:426.
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Síntomas

    Pie hinchado


    Dolor en la parte externa del pie cerca del dedo pequeño, a nivel del quinto metatarsiano


    Dolor en la zona superior interna del pie, a nivel del hueso escafoides


    Dolor en pie


    Deformidad en pie

Recomendaciones prehospitalarias

Consumir analgésicos o antiinflamatorios de venta libre.
No mover la extremidad afectada.
Estirar e inmovilizar la extremidad afectada.