Metatarsal Stress Fracture Diagnosed With High-Resolution Sonography

Stress fractures occur secondary to repeated chronic stress on a healthy bone (fatigue fracture) or to normal stress on a weakened bone, such as in the presence of osteoporosis (insufficiency fracture). 1,2 In recent years, the increase in sports activities in healthy young people has led to an increase in stress fractures, with metatarsal locations reaching an incidence of 8.8%. 1,3 Early diagnosis of a stress fracture may be challenging because the symptoms are often insidious; the clinical findings are usually nonspecific and the initial plain radiograph may reveal no or minute changes that are usually overlooked. 1,2,4 Therefore, further imaging is mandatory, with magnetic resonance imaging (MRI) and scintigraphy being considered the reference standards for the detection of stress fractures. 1,5 Although in recent years there has been growing interest in high-resolution sonography for musculoskeletal applications, there are only a few articles reporting the possibility of sonographic identification of metatarsal stress fractures. 4,6-8 We report a case of a young woman with a clinically unsuspected metatarsal fatigue fracture diagnosed using high-resolution sonography; we review the literature and discuss the role of sonography for this application.