Postpartum pelvic stress fractures with subsequent forefoot overload injury: A case report

Pelvic stress fractures in the early postpartum period are rare and may occur even in women with normal bone mineral density. This report describes the case of a 39-year-old woman (gravida 2, para 2) who developed bilateral sacral stress fractures and a left pubic ramus fracture three weeks after elective repeat cesarean delivery of a macrosomic infant. Bone mineral density and trabecular bone score were normal. She was managed conservatively with gradual clinical improvement. During recovery, she developed right forefoot pain consistent with metatarsophalangeal capsulitis and probable Morton's neuroma, likely secondary to altered gait mechanics. Postpartum pelvic stress fractures should be considered in women presenting with severe pelvic or low back pain after delivery, even in the absence of osteoporosis. Conservative management leads to favorable outcomes, although altered biomechanics during recovery may predispose to secondary overuse injuries.