Metatarsal stress fracture and bursitis

Case contributed by Dr Magdalena Chmiel-Nowak


Chronic pain in the fore- and midfoot. No acute trauma.

Patient Data

Age: 50 years
Gender: Female

Stress fracture of the 3rd metatarsal shaft with bone marrow edema, periosteal reaction and edema as well as adjacent soft-tissue edema.

The sesamoids of the great toe are somewhat laterally displaced, most likely as a result of the hallux valgus, with the metatarsal head sitting on the medial sesamoid, which shows degenerative changes. There is also bursitis in the adventitial bursa overlying the medial eminence of the 1st metatarsal head. Degenerative changes are also visible in the medial part of the 1st metatarsal head, as well as synovitis in the 1st MTP joint. 

Case Discussion

Typical features of a metatarsal stress fracture of the 3rd digit.

The diagnosis of the hallux valgus is made on a weight bearing foot radiograph, but in this case, typical changes around the 1st MTP joint are seen:

  • lateralization of the great toe sesamoids - due to a medial shift of the 1st metatarsal head
  • bursitis in the adventitial bursa adjacent to the medial metatarsal eminence - because of the pressure of the footwear and the medial eminence (due to deviation of the metatarsal head and subsequent change of medial eminence shape)

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