Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture

Abstract

Objective: The purpose of this report is to describe a fifth metatarsal stress fracture that was not detectable using conventional radiographs and was identified with diagnostic ultrasonography (US), confirmed with computed tomography, and followed through symptom resolution with US.

Clinical features: A 68-year-old woman presented to a chiropractic teaching clinic for evaluation of right foot pain. Diagnostic US examination using an 8- to 15-MHz linear array transducer showed increased vascularity, periosteal elevation, and cortical disruption of the proximal diaphysis of the fifth metatarsal suggestive of a stress fracture. The patient was referred to an orthopedic specialist for comanagement.

Intervention and outcome: The patient was treated by an orthopedist who confirmed a stress fracture using computed tomography, and she was fit with a short-leg walking boot. Serial US images were obtained to document fracture healing and exclude complications. After 6 months, the patient was asymptomatic and had resumed all of her daily activities.

Conclusion: We report a case of a proximal fifth metatarsal stress fracture that was visualized with US and followed through symptom resolution by serial examinations.

Keywords: Chiropractic; Computed tomography; Fracture; Stress; Ultrasonography.

Figures

Fig 1

Initial ultrasound. Note the cortical break, periosteal elevation (arrows) with adjacent hypoechoic area, and hyperemia observed on color Doppler. There is an absence of callus formation and soft tissue swelling. Orientation with respect to the metatarsal base is also provided.

Fig 2

Final ultrasound. Observe the prominent callus that has formed and absence of hyperemia on color Doppler. There is persistence of the slight cortical break with no corresponding hypoechoic hematoma or periosteal elevation. Soft tissue swelling is still absent.