壓力性骨折

Acute bilateral foot pain in a hyperuricemic policeman

A 46-year-old male police officer presented acute-onset right, then left foot and ankle pain and swelling after a 3000 m exercise training test 6 days ago. He was known to be a hyperuricemic patient with frequent acute gouty arthritis attacks in the past 8 years. Physical examination revealed metatarsal and ankle tenderness and swelling. His body weight was 110 kg, and body height was 180 cm. The clinical pictures suggested acute gout. While X-ray revealed stress fracture with cystic changes in the periosteal region (arrow) of the bilateral 4th metatarsals (Fig. 1). The feet were protected from weight bearing with cast immobilization and recovered gradually. Stress fractures are a common cause of injury in runners and their symptoms and early signs are nonspecific and difficult to diagnose [1]. In stress fractures that involve cortical bone such as that found in the metatarsal shaft, the earliest radiographic findings may include a subtle radiolucency, followed by thickening and sclerosis of the endosteum and periosteal new bone formation [2]. Rheumatologists should always remain vigilant for stress fractures, especially in the setting of exercise training.