Bone Stress Injuries at the Ankle and Foot

Abstract

Bone stress injuries (BSIs) are a frequent finding in athletes, particularly of the foot and ankle. A BSI is caused by recurring microtrauma to the cortical or trabecular bone exceeding the repair capacity of normal bone. The most frequent fractures at the ankle are low risk, characterized by a low risk for nonunion. These include the posteromedial tibia, the calcaneus, and the metatarsal diaphysis. High-risk stress fractures have a higher risk for nonunion and need more aggressive treatment. Examples are the medial malleolus, navicular bone, and the base of the second and fifth metatarsal bone.Imaging features depend on the primary involvement of cortical versus trabecular bone. Conventional radiographs may remain normal up to 2 to 3 weeks. For cortical bone, early signs of BSIs are a periosteal reaction or the “gray cortex sign,” followed by cortical thickening and fracture line depiction. In trabecular bone, a sclerotic dense line may be seen. Magnetic resonance imaging enables early detection of BSIs and can differentiate between a stress reaction and a fracture. We review typical anamnestic/clinical findings, epidemiology and risk factors, imaging characteristics, and findings at typical locations of BSIs at the foot and ankle that may help guide treatment strategy and patient recovery.

Effects of functional treatment of V metatarsal bone fracture in athletes – an evaluation of cases

“…The study reported that the functional therapy resulted in excellent clinical outcomes after an average follow-up of 22 months, with no significant differences based on the type of fracture. 38 This approach aligns with the findings of, 39 who suggested that athletes with fifth metatarsal fractures may benefit from surgical screw fixation, leading to optimal healing within approximately 7 to 12 weeks after surgery. However, Baumbach et al demonstrated that functional treatment without stabilization also yielded positive outcomes, emphasizing early return to activities and sports.…”

Imaging Features of Plantar Vein Thrombosis: An Easily Overlooked Condition in the Differential Diagnosis of Foot Pain

“…Insufficiency stress fractures are more common in women and older patients, even with normal loads on demineralized bone [27]. Metatarsal shafts are the most common site for stress fractures, especially of the second or third rays [43]. Initial radiographs can be negative for up to 2 to 3 weeks.…”

“…Cortical fracture lines and callus formation are better evaluated by radiographs [27]. MRI is the modality of choice, demonstrating periosteal thickening and bone marrow and surrounding reactive soft tissue edema [43]. MRI findings include jagged and irregular, incomplete or complete low signal fracture line through bone, characterized by a band of low signal intensity contiguous with the cortex on both T1 and T2-weighted images.…”