Review Question - QID 3539

The patients history, physical exam, and MRI findings are most consistent with the diagnosis of a stress fracture. Low signal on T1 and increased signal on T2-weighted images is the classic appearance of a stress fracture on magnetic resonance images. Usually the fracture appears as a linear signal band that arises from the cortex of the bone and extends perpendicular to the surface of the bone. Figures A and B show a linear area of enhancement in the posterior aspect of the calcaneus signifying a likely stress reaction from recent overtraining.

Boden et al review the pathogenesis and treatment of stress fractures. With regard to diagnosis, they state that it is primarily clinical, but imaging modalities such as plain radiography, scintigraphy, computed tomography, and magnetic resonance imaging may provide confirmation.

Gehrmann et al review stress fractures of the foot, and state that with regards to calcaneal stress injuries, MRI studies should be obtained for definitive diagnosis when radiographs are negative, and pain persists. With regards to treatment, they state that these injuries usually heal with activity restrictions, heel-pad inserts, and protected weightbearing for a short period of time.