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Stress fracture of the 3rd metatarsal

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Foot pain and swelling for weeks.

Patient Data

Age: 70 years
Gender: Male
Nuclear medicine

Linear increase in blood flow and blood pooling in the mid distal foot. 

3rd metatarsal show marked uptake in isotope indicative of reactive bone along the length of the metatrsal but especially the mid-shaft. 

Extremely subtle cortical bone erosion and periosteal new bone indicative of a stress reaction. 

Case Discussion

Note the disparity between the subtle radiographic findings (structural change) and the intensely abnormal bone scan (functional change ie reactive bone response). 

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