Subchondral insufficiency fracture - metatarsal head

Case contributed by Dr Henry Knipe

Presentation

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 plate hypointensity and depression. Marrow edema extends to the midshaft of the 2nd metatarsal. Surrounding soft tissue inflammatory change. 

Marrow edema centered on the 2nd metatarsal head where there is a plantar surface subchondral bone plate hypointensity and depression (arrows).

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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Case information

rID: 63318
Published: 28th Sep 2018
Last edited: 5th May 2019
Inclusion in quiz mode: Included

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