Foot Case #6

CC: Left foot pain HPI: 23 yo female presents to the

ED complaining of foot pain. Patient states that she recently attempted to “get back in shape” and began running 2-3 miles per day over the last week. Patient states that on second day of activity, she began noticing a dull ache in the middle of her R foot. The activity is better with rest, but has prevented her from further running since onset of pain. She denies falls, MVCs, or assaults. She denies other symptoms. She denies associated weakness or sensory changes in the extremity.

History and PhysicalVS: T: 98 P: 84 R: 16

BP: 132/76 O2: 98%RAPhysical:Musculoskeletal: LLE:

2+DP. 1+PT. No gross deformities. Minimal ttp over 3rd metatarsal. Normal active/passive ROM about ankle. <2sec cap refill. No contusion, ecchymosis, or erythema noted.

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Diagnosis: Metatarsal Stress Fracture

Typically MT stress fractures require NSAIDS and restricted activity

Post-Op shoe for comfortDue to presence of an avascular center, 5th

MT stress fractures DO require immobilization and NWB status (up to 20 weeks)

All require outpatient orthopedic referral

ED Management

History: Recent change in regimen or terrain; poor technique/footwear; minimal trauma; pain prohibits activity

Physical: Typically, a normal exam with possible tenderness over the affected MT

Xray: Periosteal reaction; no true fractureMost patients will have healing within 6

weeks

Pearls

Additional Image

ReferencesKoval, K. et al. Handbook of Fractures. 4th Edition.

2010.

Northwestern University School of Medicine: Emergency Medicine Residency Orthopedic Teaching Files http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/

Wheeles Ortho online textbook http://www.wheelessonline.com/

http://radiopaedia.org/articles/metatarsal-stress-fracture