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Ravinder Sodi, David Hall, A Man with Recurrent Fractures and Foot Pain, Clinical Chemistry, Volume 64, Issue 4, 1 April 2018, Pages 639–642, https://doi.org/10.1373/clinchem.2017.275628
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CASE
A primary care physician telephoned to inquire about the clinical significance of low alkaline phosphatase (ALP)4 in a 54-year-old man, which led to an investigation for the cause of the low ALP, a biochemical abnormality that is known to be underappreciated (1). The man was a military veteran currently working as a fireman. His records showed that he had a history of multiple fractures throughout his life, including the right clavicle at age 12 years, the left tibia with inflammation of the patellar ligament at the tibial tuberosity (Osgood–Schlatter disease) at 13 years, and the right ring finger when he was 15 years old. He reported severe foot pain starting in 2006 at age 44 years. At age 50 years, 2 separate radiographic examinations of the foot showed osteonecrosis of the second metatarsal (Freiberg disease) and loss of bone density. Around this time, he also reported a 2-week history of severe pain under the heel of his right foot. All these were observed despite no reported external injury or trauma. His current medications include corticosteroid nasal spray (mometasone furoate), dihydrocodeine, baclofen, co-codamol, quinine sulfate, propranolol, gabapentin, and diazepam.
