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Metatarsal stress fracture

Case contributed by Maulik S Patel
Diagnosis certain

Presentation

Right mid-foot localized pain and swelling for the last six weeks. No history of trauma. Radiograph at the onset of symptoms was normal. Referred for ultrasound of the foot.

Patient Data

Age: 15 years
Gender: Female
ultrasound

At the site of pain and swelling indicated by the patient, the 2nd metatarsal shaft shows callus formation, bony enlargement and posterior acoustic shadowing. There is a rim of subperiosteal fluid with adjacent soft tissue edema. However, there is no fracture line in the 2nd metatarsal bone. The rest of the metatarsals show normal cortex and contour.

x-ray

There is a periosteal reaction involving the 2nd metatarsal shaft. There is no fracture line. The rest of the bones show normal cortex and trabecular pattern. There is no dislocation/bone lesion.

Case Discussion

The case shows classic presentation and imaging findings of a metatarsal stress fracture. An adolescent girl presented with a non-traumatic onset of right foot pain for the last six weeks. The initial foot radiograph was negative. Ultrasound at six weeks shows 2nd metatarsal periosteal reaction and callus formation. The foot radiograph was done; it also shows a stress fracture.

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