Wk 1, Case 4 - Review

Patient History
62-year-old man with pain in the right midfoot.

Findings
Skeletal/osseous:
Complete but nondisplaced transverse stress fracture of the distal shaft of the 2nd metatarsal, with associated circumferential fusiform periosteal reaction/callus formation. Low-grade Osteoedema surrounding the transverse fracture.

Mild to moderate hallux valgus deformity.

Flattened fibular and tibial sesamoid grooves and Crista.

Articulations:
Moderate-sized juxtacortical osseous erosion at the medial aspect of the 1st metatarsal head, adjacent to the medial collateral ligament insertion. Mild to moderate arthrosis with slight marginal osteophytic spurring and joint space loss.

Marked tibial/medial sesamoid phalangeal arthrosis with flattening/osseous remodeling of the sesamoid groove. Moderate to marked fibular/lateral sesamoid phalangeal arthrosis with flattening and remodeling of the sesamoid groove. Flattened remodeled Crista.

Lisfranc joint:
Intact.
Tendons:
Intact and unremarkable.
Ligaments:
Intact.
Plantar plates:
Chronically frayed fibular/lateral 1st plantar plate and sesamoid phalangeal ligament.
Soft tissues:
Diffuse soft tissue swelling and edema surrounding the 2nd metatarsal stress fracture.

Moderately thickened/scarred medial collateral ligament of the 1st metatarsophalangeal joint.

Incidental mild plantar perineural fibrosis between the 2nd and 3rd metatarsal heads. No bulky Morton neuroma. No intermetatarsal bursitis.
Other:
None.

Impressions
1. Transcortical stress fracture without displacement of the 2nd mid to distal metatarsal shaft with resultant periosteal reaction/callus and surrounding soft tissue swelling.
2. Marked tibial/ medial sesamoid phalangeal arthrosis. Moderate to marked fibula sesamoid phalangeal arthrosis. Osseous remodeling/flattening of the sesamoid grooves and Crista.
3. 1st metatarsal head juxtacortical osseous erosion. Thickened scarred medial collateral ligament.