We describe the case of a 47-year-old female patient with psoriatic spondyloarthritis and fibromyalgia under regular treatment with menstrual leflux, celecoxib and gabapentin, with no relevant history and cycles.
She did not report toxic habits and her body mass index (BMI) was normal.
In a routine revision, the patient complained of pain in the feet and ankles, with no history of trauma, of mechanical rhythm, which was progressively increasing until claudication at gait, with modification of foot statics due to pain.
On examination, inflammation of ankles and feet stood out, with pressure pain and bilateral fovea.
An ultrasound was performed in the office, which showed a marked inflammation of subcutaneous cellular tissue (SCT) without signs of synovitis or Doppler signal.
An X-ray of the feet was requested, which showed no pathological findings.
Due to the significant SCT edema, the patient was referred to Angiology for evaluation.
From this service, a lymphography was requested that confirmed severe bilateral lymphocytic insufficiency.
In left foot with severe pain, MRI of the right foot showed callus fracture at 3rd and 4th MTT; and edema at 2nd MTT;
Given the MRI findings, the patient was assessed by the Traumatology Department, indicating conservative treatment with discharge and rehabilitation (magnet therapy).
Due to the finding of multiple stress fractures, we proceeded to study in our consultations, performing analysis with renal function, serum and urinary calcium, ionized calcium, magnesium and PTH, which were normal.
Only 19.5 ng/ml of vitamin D was found, so supplementation was indicated.
1.
Evaluating the case of this patient as a whole, we propose, as a predisposing factor for the appearance of stress fractures, the important alteration of the statics of the painful feet that had developed due to the severe insufficiency produced by this patient.
