Dr. Ebraheim’s educational animated video describes stress fractures of the foot, the etiology, signs and symptoms, diagnosis, and treatment options.
Usually the patient will have vague symptoms. The patient may see different doctors in order to obtain different opinions. A lot of tests are done. Female athletes who have decreased bone density and possible eating disorders will have an increased incidence of stress fracture. Female athletes with stress fractures should have a complete dietary and menstrual history. There is a correlation between eating disorders, amenorrhea and osteoporosis in female athletes.
In general stress fractures may be treated conservatively. Sometimes stress fractures require surgery.
Four common areas of stress fracture in the foot:
1-Navicular: stress fractures of the navicular bone are recognized with increased frequency especially in track and field, football and basketball athletes. It is more common in athletes with cavus foot. Pain from navicular stress fractures is poorly localized. The majority of navicular stress fractures are nondisplaced and occur due to chronic overuse. Symptoms are persistent, vague, diffuse midfoot pain that increases with activity. Localized tenderness in the navicular area. Diagnosis is usually delayed. If the clinical suspicion is high and the x-ray is negative a bone scan or CT scan should b ordered. Recently, MRI is frequently used. Treatment: short leg cast/ nonweight bearing for 6-8 weeks. Successful healing of the fracture is high when the fracture is acute. Occasionally the fracture requires internal fixation with or without bone graft. If there is sclerosis of the stress fracture, then surgery may be preferred through a small incision dorsally, avoid disruption of the blood supply. The fracture is debrided and a local bone graft is used with a dorsal lag screw. In performing athletes, surgery is recommended to minimize the disability.
2-Calcaneus: stress fracture of the calcaneus is typically felt deep in the bone and produces a vague complaint of help pain. Stress fractures of the calcaneus are typically seen I athletes who are overtraining, using improper foot wear or those with mechanical abnormalities. The pain from stress fracture appears suddenly and remains constant. Pain and swelling on both sides of the heel may be seen. The pain associated with a calcaneal stress fracture can usually be reproduced by squeezing the heel from both sides. It is important not to confuse the pain of a calcaneal stress fracture with the pain associated with other conditions of the heel such as plantar fasciitis. Always rule out calcaneal stress fracture in heel pain. Plantar fasciitis is usually fluctuating. The pain from plantar fasciitis is most severe in the morning when the patient first stands on their feet. Treatment: rest, avoid activities such as running and jumping, begin swimming to maintain conditioning and when tenderness is improved and subtalar motion returns the patient can resume activity, use proper foot wear to cushion the heel (orthotics), nonweight bearing for 6-8 weeks.
3-Metatarsals: in runners, the fracture usually occurs in the metatarsal neck. Fracture may result in delayed union. Keep nonweight bearing for 6 weeks. The fracture is sometimes called “march fracture” that occurs in military recruits and in runners who increase activity levels. It usually occurs in the 2nd metatarsal followed by the 3rd metatarsal. The fracture is diaphyseal in location and there will be localized tenderness at the fracture site. The 2nd metatarsal is the longest and most rigid of the metatarsal bone and it is usually exposed to greater repetitive stresses. X-rays are usually normal. A bone scan or MRI may be needed. Treatment: walking boot, reduced activity.
4-Proximal 5th metatarsal: the fracture occurs in a watershed area of blood supply that is susceptible to stress fracture nonunion. The blood supply in this area is tenuous. Healing is difficult with a high incidence of delayed and nonunion. The stress fracture occurs distal to the Jones fracture. The Jones fracture is an acute fracture and a stress fracture is a chronic condition that will require surgery. There are three types of fracture at the proximal fifth metatarsal: Zone I: tuberosity avulsion fracture, Zone II: stress fracture, Zone III: Jones fracture. The stress fracture occurs distal to the ligament that connects the 4th and 5th metatarsals together. The stress fracture usually occurs in cavus foot due to increased ground reaction force over the 5th metatarsal.
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Background music provided as a free download from RU-vid Audio Library.
Song Title: Every Step
1 май 2014
