Presentation
Pain at the lateral aspect of the hindfoot for two weeks. No trauma. On cortisone for rheumatoid arthritis.
Patient Data
Sagittal T1 and STIR images show a vertical fracture through the superior aspect of the calcaneal tuberosity, with extensive surrounding marrow edema. There is also diffuse edema of all soft tissues with modest effusion in the joint and in the synovial sheath of the posterior tibial and flexor hallucis tendons. Nothing else significant.
Case Discussion
There are two types of pathologic stress fractures: fatigue fractures and insufficiency fractures. A fatigue fracture is a stress fracture that results from the application of abnormal stress to the bone with normal elastic resistance. An insufficiency fracture occurs in abnormal noncancerous bone with decreased elastic strength to normal stress and is most often associated with osteopenic or osteoporotic bone. Pathologies that facilitate insufficiency fractures are metabolic disorders, inflammatory conditions, bone dysplasias, neurological disorders, and drug therapy.
Radiographer: TSRM Fabio Imola
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