0:00

All right, so this is our companion case

0:03

to the metatarsal stress fracture.

0:05

This is a 75-year-old woman who had a traumatic left ankle

0:10

and foot pain that began about two weeks ago, um,

0:14

prior to this imaging.

0:16

So let me pull up, here's our ST one weighted images,

0:21

Sagal T two Fat Suppress.

0:23

Here's our, uh, coronal oblique

0:27

and our coronal fluid sensitive.

0:30

So here the marker is at the plantar aspect of the heel,

0:34

right beneath the marker, large plantar cal site,

0:38

some thickening of the proximal portion of the central cord

0:41

of the plantar neurosis, some heel pad fibrosis,

0:44

and maybe a little touch of edema.

0:46

So should we just call this plantar fasciitis and move on?

0:50

Uh, obviously that's not the salient finding,

0:53

and this is supposed to be about bones

0:54

and related to the metatarsal stress fracture.

0:58

Um, so here we can see

1:00

the salient finding is this bone edema within the calcaneus,

1:05

and then we can see this hyperintense fracture line.

1:08

In this case, it looks like the fracture line is, um,

1:11

extending a little bit posterior

1:13

to the posterior calcaneal facet

1:15

and then into the calcaneal body.

1:19

So this is compatible with a stress fracture in this person.

1:24

Post-menopausal female.

1:25

The history was that they had no activity, no injury.

1:29

I think this is most likely gonna be an

1:31

insufficiency for fracture.

1:33

Um, as Dr. Raznick mentioned,

1:35

calcaneus is the second most common location

1:38

for a stress fracture of the lower extremity,

1:40

second only to the tibia.

1:43

And you'll note that unlike the metatarsal fracture

1:46

that we saw earlier, there's really not a lot

1:49

of cortical thickening or periosteal callus formation.

1:54

And that's because the stress fracture

1:55

of the calcaneus is principally involving the trabecular

1:59

or medullary bone, um, rather than the cortical bone.

2:04

If we scroll through some of the other tarsal bones here,

2:07

I think there are patchy bits of edema involving

2:10

multiple additional tarsals.

2:12

So for example, here at the Alis, um,

2:15

little bit at the navicular, some

2:17

of the kineo forms as well.

2:19

At those sites I'm not seeing, um, true fracture lines.

2:23

So those may be additional sites

2:25

of stress changes without fractures.