Stress fracture of the second metatarsal is classically described in amenorrheal dancers. However, this patient is of an age that a fragility fracture should be considered. Metatarsal stress fractures can be successfully treated with a short-leg cast, low walking boot, or hard-soled shoe with arch support. MRI is a useful screening tool, but CT better visualizes bone when the fracture is visible on plain radiographs. The reference by Bogoch et al created a multidisciplinary team to enroll a cohort of patients at risk for osteoporosis. They found that >95% of patients were appropriately diagnosed, treated, or referred for osteoporosis care with use of this team.
Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM. Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am. 2006 Jan;88(1):25-34
PMID:16391246 (Link to Abstract)
Fischgrund JS (ed): Orthopaedic Knowledge Update 9. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2008, pp 189-196