STRESS-FRACTURES OF THE HEADS OF THE METATARSALS - A NEW CAUSE OF METATARSAL PAIN

We report 16 cases of epiphyseal metatarsal stress fractures in 11 pat ients. Four patients had osteoporosis and two of these four were under fluoride therapy. Three of the fractures occurred upon resumption of weight-bearing. The fractures were distributed over the five rays; sev en fractures were located to the second metatarsal. Manifestations wer e acute focal metatarsal pain, diffuse edema of the forefoot and infla mmatory metatarsophalangeal arthropathy. Delayed, transient visualizat ion of a linear area of epiphyseal sclerosis occurred in 14 cases. Rad ionuclide bone scans consistently showed early accumulation of the tra cer in the metatarsal head. The focus of increased activity extended t o the shaft in three cases. The main differential diagnoses are second ray syndrome, metatarsophalangeal arthritis, focal radial reflex symp athetic dystrophy of the foot and osteonecrosis of the metatarsal head s. The clinical and roentgenographic outcome was consistently favorabl e after one month without weight-bearing. These fractures can simulate , complicate, induce (two cases), reflex sympathetic dystrophy of the foot or occur concomitantly with (two cases).