About 6 weeks ago I started having pain in my extensor pollicis longus and in the medial arch of my foot. It was only really bad when walking around bare-foot, barely any pain while walking or running in any types of shoes. I waited until after IMLP to get it checked out since it was staying very consistent even with training.
The doc saw nothing on xray, thought it was tendonitis (probably PTT) or possible a navicular stress fracture so did an MRI. Results were a second metatarsal stress fracture.
I have no pain in this region of my foot, no pain on the top of my foot or swelling, and I can walk around in flip flops no problem. I am not running now since the diagnosis, but I still think the pain is not from the stress fracture, but some sort of tendinopathy on the medial side of my foot.
Any one have a similar experience, or docs who have opinion? I tried to ask the ortho doc about this but he just dismissed what I thought. Is there such thing as a benign, pain free stress fracture, or could this pain in my first toe come from a stress fracture at the base of the second metatarsal??
I see you are a med student (BTW, I did my residency in CT). There is one thing you will learn soon enough - treat patients, not studies.
False positive, other causes for medullary edema, etc. Also, you mentioned the base of the 2nd met where you would rarely see a 2nd met stress fracture. Something just doesn’t add up …
yeah. unfortunately being a second year med student means I still dont know enough to self diagnose. That is what I thought though, that the diagnosis sounded odd, I guess I’ll just play the pain game by ear, and avoid anything that causes pain. Weirdly though, running does not cause pain, but I guess that should still be avoided for the time being.
The MRI findings say “mild bone marrow edema signal involving base of second metatarsal with suggestion of associated stress fracture. No significant juxtacortical edema.” with impression “stress fracture base 2nd metatarsal”
Thanks for the opinion! being dismissed by a doc is a good lesson for the future on how not to treat patients
I see you are a med student (BTW, I did my residency in CT). There is one thing you will learn soon enough - treat patients, not studies.
False positive, other causes for medullary edema, etc. Also, you mentioned the base of the 2nd met where you would rarely see a 2nd met stress fracture. Something just doesn’t add up …
Get a second opinion emphasizing the site of YOUR pain not the site of medullary edema. Often there is a disconnect between the patient, radiologist reading the films, and the treating physician.
Yeah, what you HAVE is marrow edema at the base of the 2nd met. That is it.
This is best termed a “stress reaction” since you have no cortical involvement and hence no “official” stress fracture. I promise a cortical fracture/stress fx will be painful in most all patients :0
Likely from your gait antalgia (more than you realize) from your insertional PT tendonopathy or whatever.
This seems like a good forum to respond to. I obviously had a stress fracture of the 2nd Metatarsal, that actually turned into a full fracture. I had no symptoms of a stress fracture, no tenderness, no swelling, no pain. I completed a 10 mile in Michigan in August, no problem. Finished a 5K on my own three days later, no problem. Signed up for a 5K for fun on Friday, the 13th of September, and experienced what I thought was a toe cramp. Since I can usually work these out, I continued and finished the 5K. That evening, I had a little swelling, and thought it was a soft tissue injury, so I soaked my foot in epsom salt and went to bed. The next morning, the foot was bruised, and I could not place any weight on the foot at all. I went to the emergency room where x-rays revealed a non-displaced fracture of the 2nd metatarsal, in the middle of the bone. The unusual part about this injury is it was a nice, easy 5K, not timed with no stress. This was a non-competitive event. Either I have an extremely high tolerance for pain, or the bones are beginning to deteriorate due to my age. I am 52.