Foot and ankle stress lesions: MRI diagnosis and conservative treatment

Abstract

Bone contusion and stress fractures are frequent lesions, usually, not diagnosed in cases of pain in the foot and ankle, of unspecified causes. Objective: Cases of bone contusion and stress fractures of the foot and ankle attended between 2002 and 2008 were retrospectively analyzed. Methods: Fifty-five files of patients (58 feet), that claimed unspecified pain or local pain without radiological changes and that remained asymptomatic, were reanalyzed. All the patients were submitted to MRI investigation. Results: Thirty patients (53%) were diagnosed as bone contusion and 26 (47%) were diagnosed as stress fractures. The affected side was the same with right foot with 35 feet and the left foot with 23 feet. The most affected bones were calcaneus (with five cases), talus (eight cases), cuboide (one case), distal end of fibula (with two cases), distal end of tibia (with seven cases), navicular (with four cases), the bottom of the second metatarsus (with 21 cases), third metatarsus (with ten cases) and one case of fourth metatarsus. The average age was 48.5 years old (18-80). The average follow-up treatment was of three months (two-30). Conclusions: In symptomatic patients with normal radiological tests, the MRI was the most specific exam to determine the diagnosis. The treatment was non surgical in all cases, however after the second half of the analyzed period (2005-2008), the treatment became more effective with the use of full contact insole, in association with the use of Diosmine 450 mg/ Hespiridina 50 mg in a minimum period of 60 days with clinical status in all cases.