Subchondral insufficiency fracture - metatarsal head

Case contributed by Henry Knipe
Diagnosis almost certain


Four weeks of forefoot pain and swelling.

Patient Data

Age: 60 years
Gender: Female

Marrow edema centered on the 2nd metatarsal head where there is a plantar surface subchondral bone linear hypointensity and depression. Marrow edema extends to the midshaft of the 2nd metatarsal. Adjacent periosteal and soft tissue edema. 

Case Discussion

Subchondral insufficiency fractures are a common cause of acute, severe, non-traumatic musculoskeletal pain. They most commonly occur in the knee (previously known as SONK). The key differential is a stress reaction/fracture - in the metatarsals, these tend to occur in younger patients and the marrow changes are centered on the shaft, often with cortical and periosteal reactions. 

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