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Fifth metatarsal stress fracture — MRCGP AKT MCQ

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HardAnkle and FootFifth metatarsal stress fractureMRCGP AKT

A runner has focal proximal fifth-metatarsal pain after a rapid mileage increase and cannot walk comfortably. Initial radiographs are normal but clinical suspicion of a stress injury remains high. What is the next investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — MRI plus suspension of impact loading

The best answer is “MRI plus suspension of impact loading”. Early stress injury can be radiographically occult; MRI detects marrow and cortical stress change and helps grade a potentially high-risk proximal fifth-metatarsal lesion. Continued impact loading risks progression and non-union, while ultrasound and vascular imaging do not answer the clinical question.

Reference: NICE NG226: Osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations