The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Ultrasound Image Review: A 30-Year-Old Woman with Left Foot Pain

Ultrasound Image Review: A 30-Year-Old Woman with Left Foot Pain

May 17, 2019 • By Eugene Kissin, MD, RhMSUS, & Catherine Bakewell, MD, RhMSUS

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Presentation

A 30-year-old woman presented to her rheumatologist for left foot pain of three weeks’ duration. She was followed for systemic lupus erythematosus manifesting in arthritis and hemolytic anemia, as well as anti-nuclear antibody and Smith antibody positivity, and was treated with hydroxychloroquine and prednisone in the 2.5–10 mg per day range. She was symptom free for six months prior to the development of her foot pain and had tapered off prednisone six weeks prior to her visit. Every day for the previous month, she had walked a mile to the hospital for her sick child. Her foot pain was much worse with weight bearing, but she had no other symptoms of disease. Her examination revealed normal vital signs and localized tenderness over the third metatarsal.

You Might Also Like
  • Diagnostic Imaging in Lupus Patient with Foot Pain: Findings
  • Diagnostic Imaging in Lupus Patient with Foot Pain: History
  • Podiatry for Rheumatologists: Treating Patients’ Foot Complaints
Explore This Issue
May 2019

The Ultrasound

Panel “a” in the figure above shows a longitudinal ultrasound image of the dorsal aspect of the third metatarsal, with hazy, hyperechoic material over the metatarsal shaft, outlined by an anechoic lining. This appearance is produced by periosteal elevation and edema. The arrow head points to synovial tissue of the metatarsal joint, which was neither tender to sonopalpation, nor hyperemic on Doppler imaging.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Panels “b” and “c” demonstrate hyperemia surrounding the periosteum on longitudinal and transverse Doppler imaging, but not the joint synovium.

Ultrasound Image Review: A 30-Year-Old Woman with Left Foot PainPanel “d” depicts a radiograph of the foot, with an arrow pointing to the barely visible elevated periosteum, corresponding to the region of stress fracture.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Treatment & Discussion

The patient was treated with a walking boot, and her symptoms resolved. Ultrasound can demonstrate superficial bone lesions involving the periosteum, including stress fractures, and may be able to detect such lesions more easily than pain film radiography, although this question has not yet been systematically evaluated.1

One study published last year did find that emergency medicine residents were better able to identify long bone fractures using ultrasound than with X-ray (accurate identification mean proportion 0.89 vs. 0.75, respectively [P<0.001]). This difference was more pronounced as the level of ultrasound and emergency department experience increased.2

Stress fractures are more likely to occur in patients with rheumatic conditions, not only due to a predisposition to osteoporosis from the condition itself, but often due to concomitant treatment with glucocorticoids. Stress fractures of the tibia, metatarsals and fibula are the most frequently reported.3

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

The authors are mentors for USSONAR, a society of rheumatologists, physicians and health professionals working to promote the use of musculoskeletal ultra­sonography to advance the care of patients with rheumatic diseases. Learn more.

Discover

The ACR offers an RhMSUS certification program. Learn more.

Pages: 1 2 | Single Page

Filed Under: Conditions Tagged With: Fractures, Glucocorticoids, stress fracture, UltrasoundIssue: May 2019

You Might Also Like:
  • Diagnostic Imaging in Lupus Patient with Foot Pain: Findings
  • Diagnostic Imaging in Lupus Patient with Foot Pain: History
  • Podiatry for Rheumatologists: Treating Patients’ Foot Complaints
  • New Musculoskeletal Ultrasound Course

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)