Stress Fracture

This condition can occur when there is a fracture to the bone that cannot be detected initially by an x-ray, but shows up later with healing evident.

 

 

 

 

In this xray, an elderly female presented with no known trauma but pain in her heel. She had tenderness when the heel was squeezed from side to side. Given her history of osteoporosis, a stress fracture was suspected, but was difficult to confirm on x-ray.

 

 

 

 

One month later, however, the healing could be seen on a repeat x-ray, looking like a cloud or cotton ball forming in the middle of the bone. At this visit, she was also feeling better.

 

 

Here is a case where the fracture of the shaft of the second metatarsal is not evident initially, but the later film shows healing as indicated by the white arrow.  In cases like this, a presumptive diagnosis is made at time patient presents for evaluation, but is confirmed by a later X-ray.

If a confirmation of the diagnosis were needed right away, an MRI would show the fracture, but the treatment in most cases would be the same:  a post op shoe.