D. Lechevalier et al., STRESS-FRACTURES OF THE HEADS OF THE METATARSALS - A NEW CAUSE OF METATARSAL PAIN, Revue du rhumatisme, 62(4), 1995, pp. 255-259
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).