Recurrent Fractures in a 25-Year-Old Graduate Student

Heidi Moawad, MD


September 29, 2023

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A 25-year-old graduate student presents to her primary care physician for evaluation and treatment of acute pain in her left heel. For the past 3 days, she has avoided placing pressure on the heel because of the pain.

About 6 months ago, she experienced a small stress fracture of her femur, which may have occurred while she was exercising. The patient is concerned that she may have another fracture. Her first fracture occurred while she was working out on a treadmill, and this new heel pain developed about 20 minutes after an outdoor run. She initially thought that it might be plantar fasciitis and performed some exercises that she found online for relieving that condition, but the pain worsened.

The patient reports that she exercises twice per day and includes weight training and cardio workouts in each 1-hour session. She is not a competitive athlete; she exercises to maintain her body weight. She also says that she watches her diet to maintain a low calorie intake and adds that she is "kind of anorexic"; however, she does not consider her dietary habits or her level of exercise to be problematic.

Over the past year, the patient has missed a few of her menstrual periods, which she attributes to stress. She does not use oral contraceptives and has not been sexually active for the past 18 months.


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