IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Metatarsal fatigue and insufficiency (stress) fractures

Case contributed by Yuan Ling
Diagnosis certain

Presentation

Fit and healthy runner with midfoot pain.

Patient Data

Age: 55 years
Gender: Male

Extensive marrow edema signal of the 2nd metatarsal base and diaphysis is compatible with bone stress. Cortical breach with periostitis indicates a stress fracture. Florid surrounding soft tissue inflammation. 

This is a classic location. Note that the 2nd metatarsal is the longest, therefore bears the most weight.

Treated with 4 wk in a cam...

mri

Treated with 4 wk in a cam walker moon boot Went on holiday for 4 weeks. Returned with increasing forefoot pain.

Stress fracture at the 2nd metatarsal proximal diaphysis is healing, with more mature cortical and periosteal new bone. However, marrow hyperintensity has progressed to the neck and head region, and surrounding soft tissue inflammation is also more distal. Subchondral linear hypointensity along the plantar aspect of the metatarsal head is compatible with insufficiency fracture.

Case Discussion

The initial stress fracture is due to fatigue - repetitive mechanical overload in normal bone.

Disuse osteopenia following a period of rest in a cam walker results in demineralization and loss of bone strength.

Subsequent reloading of the foot resulted in a subchondral insufficiency fracture at the metatarsal head - normal load but in abnormal, weakened bone.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.