We reviewed the cases of four female ballet dancers with a stress
fracture of a type that has not been reported previously. This fracture
occurs in the proximal portion of the second metatarsal and involves the
volar and medial aspects of Lisfranc's joint. A differential diagnosis of
pain in the middle part of the foot in a dancer should include a
consideration of this entity, which can be very difficult to diagnose on
initial assessment. Oblique radiographs, tomograms, and a bone scan may be
necessary to confirm the diagnosis. With early recognition and diagnosis,
in three of the four patients the fracture healed with immobilization and
modified training. One patient required surgical resection because of
persistent non-union of the necrotic fracture fragment.