2. R: 16
BP: 132/76 O2: 98%RA
ED complaining of foot pain.
Physical:
Patient states that she recently
attempted to “get back in shape”
and began running 2-3 miles per Musculoskeletal: LLE:
day over the last week. Patient
2+DP. 1+PT. No gross
states that on second day of
deformities. Minimal ttp
activity, she began noticing a dull
ache in the middle of her R foot.
over 3rd metatarsal.
The activity is better with rest, but
Normal active/passive
has prevented her from further
running since onset of pain. She
ROM about ankle. <2sec
denies falls, MVCs, or assaults. She cap refill. No contusion,
denies other symptoms. She
ecchymosis, or erythema
denies associated weakness or
sensory changes in the extremity.
noted.
CC: Left foot pain
HPI: 23 yo female presents to the
VS: T: 98 P: 84
3.
4.
5. Typically MT stress fractures require NSAIDS and
restricted activity
Post-Op shoe for comfort
Due to presence of an avascular center, 5th MT stress
fractures DO require immobilization and NWB status
(up to 20 weeks)
All require outpatient orthopedic referral
6. History: Recent change in regimen or terrain; poor
technique/footwear; minimal trauma; pain prohibits
activity
Physical: Typically, a normal exam with possible
tenderness over the affected MT
Xray: Periosteal reaction; no true fracture
Most patients will have healing within 6 weeks
7.
8. Koval, K. et al. Handbook of Fractures. 4th Edition. 2010.
Northwestern University School of Medicine:
Emergency Medicine Residency Orthopedic Teaching
Files
http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-teaching/
Wheeles Ortho online
textbook http://www.wheelessonline.com/
http://radiopaedia.org/articles/metatarsal-stressfracture
