No labs performed
-Foot plain films are normal, no abnormalities or fractures seen. Case Photo #1, Case Photo #2
-Bone scan shows hypermetabolic activity involving the base of the right second metatarsal. Case Photo #3
-Diagnosis of stress fracture of right second metatarsal was made, and the patient was placed in a walking boot for 6 weeks with improvement, but not resolution of pain.
-After a gradual return to play program over 5 weeks, the patient noted increased pain during her first competitive tennis match.
-Repeat x-rays are negative, show no fracture, but also no callus formation.
-MRI of the right foot 11 weeks after initial presentation reveals an abnormal focus of marrow replacement, 11mm in size, involving the dorsal aspect of the proximal second metatarsal, corresponding to the location of previous lesion seen in bone scan. The lesion is rounded in appearance and without evidence of periostitis. Case Photo #4
-High Resolution CT of the right foot shows a lucent rounded lesion, with central nidus measuring 7mm in diameter, involving the base of the right second metatarsal medially and extending into the joint space, with surrounding sclerosis, suggestive of osteoid osteoma. Case Photo #5
Orthopedic surgery saw the patient, discussed conservative treatment vs surgical excision, and decided on surgery.
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