Researchers in the United Kingdom  conducted a five-year retrospective analysis of midfoot fractures to better understand the epidemiology of these injuries. Their findings suggest that most midfoot fractures result from low-velocity falls or sports-related twisting, and that females are more likely to sustain this type of midfoot fracture.  Conversely, males are more likely to sustain midfoot fractures from higher energy sports-related twists, falls, crushing or direct blows.

Charles M. Court-Brown, of the Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, and colleagues analyzed data from 116 midfoot fractures (113 patients) treated at their institution between 1998 and 2002. Their study is slated to appear in The Foot [Court-Brown, DM, et al. “Classification and epidemiology of mid-foot fractures.” The Foot, September 2006, Vol. 16 (3), page 138].

Overall, the population was 55.8% female and 44.2% male, average ages of 40.2 years and 32.7 years, respectively.

Nearly 63% of the fractures were type I avulsion fractures: 43.8% from a twist and 32.9% from a fall. Females consisted of 73% of the group with type I fractures.

The remaining midfoot fractures tended to be associated with higher-energy impacts, the authors noted, such as direct kicks during sports activities, falls from more than a standing height or traffic accidents. Of these, 15.5% were type II shear fractures, 11.2% were type III uniarticular impaction fractures and 10.3% were biarticular impaction fractures. The majority of these occurred in males, 72%, 61% and 92%, respectively.

Overall, 60% of the female patients presented with a cuboid fracture, compared with 37% of the male patients, the authors noted, while just 36% of females presented with navicular fractures compared with 54% of males. Only 6% of the patients presented with cuneiform fractures.

The authors also found that 51% of the female patients were less than 40 years of age, compared with 82% of the male patients.

These results suggest that “overall, males tend to be younger, to be injured in higher-energy accidents and to fracture their navicular, whereas females are older, injured in low-energy injuries and fracture their cuboid,” the authors wrote.

They suggested that age-related osteopenia may be associated with the etiology of midfoot fractures in female patients.