We describe the case of a 58-year-old woman.
She had a history of hysterectomy at age 42 due to metrorrhagia secondary to fibroids.
Two years earlier, the patient had been assessed for lumbar densitometric osteoporosis (L1-L4 T-score of -3, normal femoral neck figures), treated with denosumab and normal family habits fracture.
She presented with mechanical pain in the left foot, of acute onset, without inflammation or triggering cause, which had increased in intensity until she was refractory to NSAIDs.
On examination there was no remarkable finding, except pain upon mobilization of the left forefoot.
No alterations in foot statics were observed.
The patient had an X-ray of the feet that showed no pathological findings.
A left foot MRI was requested, which revealed a stress fracture in the second MTT with peripherical callus and edema of soft tissues.
An analytical study was carried out highlighting the increase of PTH and vitamin D levels (103.7 pg/ml and 272 ng/ml, respectively), attributed to the excess of vitamin D supplementation. Urinary function, serum calcium and serum calcium were normal.
Vitamin D and denosumab supplements were discontinued.
Assessed by the Traumatology Service, conservative treatment was indicated with discharge, relative rest, NSAIs and magnetotherapy, with progressive improvement.
Due to the patient's age, 58 years, and the predominance of osteoporosis at the lumbar level, a new foot was considered suitable for treatment with SERMS (the same cause of pain in the left ventricle), without calcium supplements with vitamin D.
A X-ray was requested which showed a callus of old fracture in 2o MTT due to previous stress fracture, without other findings.
A left foot MRI was performed to complete a study that showed edema of 1st and 3rd MTT, of cuneiform, scaphoid and talus bones, and posterior tibial tenosynovitis.
A new bone densitometry was requested, which showed a lumbar spine T-score of -3.5.
The patient had not continuously taken baoxifene and vitamin D, so we insisted on the importance of resuming the figures of bone mineral density, which had worsened.
The fractures were treated with rehabilitation and discharge with progressive improvement.
1.
Evaluating the case globally, we considered osteoporosis as a predisposing factor, since the patient was not obese, had neither trauma nor other risk factors.
The fact that the two episodes of pain began the same month (coinciding with season change) with a year of difference, seemed to us a striking finding.
The patient reported no change in her habits or physical activity (sedentary) in these times, so we consider that perhaps the change in the type of footwear may suppose new stress left foot fractures.
