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Stress Fracture, Ankle and Foot
Corrie M. Yablon, MD; Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Stress fracture: chronic, repetitive injury that leads to incomplete or complete fracture
            • Insufficiency fracture: fracture due to normal stress on weak bone
            • Fatigue fracture: fracture due to abnormal stress on normal bone; in practice, there is often overlap between fatigue and insufficiency fractures
            • Pathologic fracture: fracture due to underlying tumor or infection
            • Stress injury: bone marrow edema or long-segment periosteal reaction without fracture line; can progress to fracture

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Hodes A et al: Metatarsalgia. Radiol Clin North Am. 56(6):877-92, 2018
                                  2. Mandell JC et al: Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol. 46(9):1165-86, 2017
                                  3. Mandell JC et al: Stress fractures of the foot and ankle, part 1: biomechanics of bone and principles of imaging and treatment. Skeletal Radiol. 46(8):1021-9, 2017
                                  4. Welck MJ et al: Stress fractures of the foot and ankle. Injury. 48(8):1722-6, 2015
                                  5. Yu SM et al: MRI of isolated cuboid stress fractures in adults. AJR Am J Roentgenol. 201(6):1325-30, 2013
                                  6. Brockwell J et al: Stress fractures of the foot and ankle. Sports Med Arthrosc. 17(3):149-59, 2009
                                  7. Mann JA et al: Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin. 14(2):187-204, 2009
                                  8. Burne SG et al: Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Am J Sports Med. 33(12):1875-81, 2005
                                  9. Franco M et al: An uncommon cause of foot pain: the cuboid insufficiency stress fracture. Joint Bone Spine. 72(1):76-8, 2005
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Stress fracture: chronic, repetitive injury that leads to incomplete or complete fracture
                                            • Insufficiency fracture: fracture due to normal stress on weak bone
                                            • Fatigue fracture: fracture due to abnormal stress on normal bone; in practice, there is often overlap between fatigue and insufficiency fractures
                                            • Pathologic fracture: fracture due to underlying tumor or infection
                                            • Stress injury: bone marrow edema or long-segment periosteal reaction without fracture line; can progress to fracture

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    • Nuclear Medicine Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Hodes A et al: Metatarsalgia. Radiol Clin North Am. 56(6):877-92, 2018
                                                                  2. Mandell JC et al: Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol. 46(9):1165-86, 2017
                                                                  3. Mandell JC et al: Stress fractures of the foot and ankle, part 1: biomechanics of bone and principles of imaging and treatment. Skeletal Radiol. 46(8):1021-9, 2017
                                                                  4. Welck MJ et al: Stress fractures of the foot and ankle. Injury. 48(8):1722-6, 2015
                                                                  5. Yu SM et al: MRI of isolated cuboid stress fractures in adults. AJR Am J Roentgenol. 201(6):1325-30, 2013
                                                                  6. Brockwell J et al: Stress fractures of the foot and ankle. Sports Med Arthrosc. 17(3):149-59, 2009
                                                                  7. Mann JA et al: Evaluation and treatment of navicular stress fractures, including nonunions, revision surgery, and persistent pain after treatment. Foot Ankle Clin. 14(2):187-204, 2009
                                                                  8. Burne SG et al: Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Am J Sports Med. 33(12):1875-81, 2005
                                                                  9. Franco M et al: An uncommon cause of foot pain: the cuboid insufficiency stress fracture. Joint Bone Spine. 72(1):76-8, 2005