The patient underwent an excisional biopsy curettage of the tumor from the right second metatarsal base with a concurrent bone graft at the site of excision.
Pathology report was consistent with osteoid osteoma. She was able to gradually increase weight-bearing status with good healing and return to competitive tennis.
This case illustrates the importance of broad differential diagnosis and further evaluation in a patient with symptoms consistent with stress fracture that does not respond to conservative treatment.
Bone scan and MRI are both accepted options for diagnosis of presumed stress fracture, with the expense and lack of radiation of MRI weighed against less expense but radiation exposure and a 4 hour return visit for bone scan. In this case, the more sensitive MRI would have found the lesion at the time of initial workup. It is not clear in the timing of this case if that would have saved the patient's lost competitive season, but that could have been an important difference in outcome for the patient.
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