0:00

Let's look now at stress fractures involving the midfoot

0:03

and forefoot, and I'm gonna emphasize the

0:06

tarsal navicular bone.

0:08

This is an old case, the images are not pretty,

0:11

but it emphasizes that in the coronal plane

0:14

where you wanna look for these stress fractures,

0:17

they typically occur, occur dorsally.

0:21

They occur approximately,

0:23

and they're generally vertical or vertical.

0:26

O obliged. So this is a beautiful example of

0:29

what they look like in the coronal plane.

0:33

If we look at them in the transverse plane as here,

0:36

you can see again the dorsal proximal location of them,

0:41

the vertical obl nature,

0:44

and the widespread marrow edema that may be seen.

0:48

This is a very important site

0:50

of a stress fracture in the midfoot,

0:53

and you should always remember this particular site.

0:56

One more example, showing you

0:59

what they look like in the coronal

1:01

and transverse plane, dorsal proximal

1:06

sagittal or vertical or vertical

1:08

or like shown beautifully in the this exam.

1:14

Now there is another condition, perhaps some

1:18

of you have not heard of it.

1:19

It is called Mueller We Syndrome.

1:22

It's been written up in the literature

1:24

as spontaneous osteonecrosis of the,

1:28

uh, navicular bone.

1:30

But in my view, as you look at this,

1:32

this is more likely a stress fracture that goes on perhaps

1:37

to a complete fracture with bone fragmentation

1:41

and secondary osteonecrosis of bone.

1:45

This is an example of

1:46

what Mueller Weiss syndrome may look like.

1:51

Let's move on and talk about stress fractures involving the,

1:55

uh, midfoot and forefoot.

1:57

And I've illustrated here where, where the typical

2:01

locations are the base of the great toe metatarsal,

2:06

the shaft or neck of the second through fourth metatarsal,

2:10

and perhaps the base

2:11

or proximal shaft of the fifth metatarsal.

2:15

In this particular example,

2:17

I'm showing you in fact a metatarsal stress fracture

2:21

involving the proximal shaft of a metatarsal, a classic,

2:26

uh, appearance and location.

2:30

When we have metatarsus abductus owing to the position

2:35

of the foot, finding stress fractures involving the base

2:40

of the lateral metatarsals may be seen in this example.

2:44

Stress fractures of the fourth

2:46

and fifth metatarsals can be appreciated.

2:52

And there is a condition,

2:53

and you may hear a little bit more about it later known

2:56

as freiberg's infraction

2:59

It, although the literature might suggest it is a primary

3:03

osteonecrosis of bone.

3:05

In my view, this too is a stress fracture

3:09

involving the, uh, head of, of the, uh,

3:13

second metatarsal most commonly,

3:16

although it can involve other metatarsals

3:19

and can be unilateral

3:20

or bilateral associated

3:23

with marrow edema shown in the mr.

3:26

And in this case, with something

3:28

that would be under the general category of sesamoiditis.

3:33

There is partitioning of the medial sesamoid.

3:36

Is it a fracture? Is it developmental?

3:39

That is often a difficult, uh, problem here.

3:42

Another example of a partition medial sesamoid

3:47

involving the great toe, the level

3:50

of the metatarsal head producing pain.

3:52

And in my view, this is sesamoiditis,

3:57

a general term for a painful sesamoid.