Case: Pt is a 23 y/o women training for a marathon who presented with increasing pain over past few weeks in her foot during exercise. The pain was focal, sharp and exacerbated by weight bearing and relieved by rest. It had been occurring with increasing severity, and earlier in her running. On physical examination the third metatarsal is noted to be tender. Otherwise, the exam is normal. The patient was sent for plain radiographs of foot (see attached picture).
Description of Foot X-ray:
Third metacarpal with hazy calcification adjacent to the mid shaft of the bone along with a subltle lucency extending across the medial cortex of the metacarpal at the site. There is no deformity. This has the appearance of a stress fracture.
Follow-up:
Given evidence of stress fracture, the patient was told to rest, substitute running with lower impact sports such as swimming, stretching and strengthening exercises. After six weeks, she slowly returned to running with improvement of her symptoms.
There are multiple possible causes that present as bone pain. A useful differentiation can be separating into focal vs. diffuse pain.