We describe the case of a 47-year-old patient being followed up for psoriatic spondyloarthritis and fibromyalgia, on treatment with leflunomide, celecoxib and gabapentin, with no history of interest and with regular menstrual cycles. She reported no toxic habits and her body mass index (BMI) was normal. During a routine check-up, she reported pain in her feet and ankles, with no history of trauma, of a mechanical rhythm, which progressively increased until it caused claudication on walking, with modification of the statics of her feet due to the pain. On examination, there was swelling of the ankles and feet, with pain on pressure and bilateral fovea. An ultrasound scan was performed in consultation, which revealed very marked inflammation of the subcutaneous cellular tissue (TCS) with no signs of synovitis or Doppler signal. A foot X-ray was requested, which showed no pathological findings. Due to the significant SCT oedema, the patient was referred to Angiology for assessment. Angiology requested a lymphography scan which confirmed severe bilateral lymphatic insufficiency. As the clinical manifestations of intense pain with claudication persisted, an MRI of the feet was ordered, which showed a fracture callus in the right foot in the 3rd and 4th MTT and oedema in the 2nd MTT; and in the left foot a fracture line in the 1st MTT, and oedema in the 3rd and 4th MTT and in the surrounding tissue. Given the findings of the MRI, the patient was assessed by the Traumatology Department, which indicated conservative treatment with unloading and rehabilitation (magnetotherapy). Due to the finding of multiple stress fractures, a study was carried out in our consulting rooms, and analyses were performed with renal function, serum and urinary calcium, ionic calcium, magnesium and PTH, which were normal. Only a vitamin D level of 19.5 ng/ml was found, and supplementation was indicated.

Assessing the case of this patient as a whole, we considered, as a predisposing factor for the appearance of stress fractures, the significant alteration of the antalgic foot statics that she had developed due to the pain caused by the severe lymphatic insufficiency that she suffered.