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Foot fracture from walking: Foot & Ankle Stress Fractures: Causes, Symptoms, Treatments

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Foot & Ankle Stress Fractures: Causes, Symptoms, Treatments

What is a stress fracture?

A stress fracture is a type of bone break or crack in the bone. Stress fractures occur when a small or moderate amount of force is applied to a bone repeatedly and over time. This is different from a traumatic fracture, in which a significant amount of force is applied suddenly, such as in the case of a severe ankle twisting injury, which can cause acute ankle fractures, or in a car collision, when bones in the foot may be broken or crushed).

Stress fractures are common in foot and ankle bones because we continually place force on them by standing, walking, running and jumping. In a stress fracture, the bone breaks but usually does not shift position (become “displaced”).

The forces that cause a stress fracture in the foot or ankle are similar to those when you bend a paper clip. If you gently bend a paper clip once, it will not break. But if you continue to bend it back and forth multiple times, the metal becomes weakened (or “fatigued”) and eventually breaks. Bones that are subjected to repetitive force can experience a similar type of fatigue called a “stress reaction.” This increases the risk that the bone will eventually break, that is, suffer a stress fracture.

Causes of a stress fracture in the foot and ankle

Stress fractures generally occur by one of two ways:

  • People with healthy bones overuse the foot and ankle by frequent, repetitive motion. This is particularly the case in athletes who participate in high-impact sports such as running track and field, football, basketball, soccer, tennis, gymnastics or cheerleading.
  • People who have very weak bones from a separate, underlying condition (such as osteoporosis) sustain a stress fracture in the foot even from fairly low-impact activities such as frequent walking. This type of stress fracture is called an “insufficiency fracture” because it happens in a bone that does not have “sufficient” density or strength to withstand normal impact forces. Insufficiency fractures can sometimes affect younger, otherwise healthy women who exercise excessively, because such activity can lead to irregular or absent menstrual cycles, which in turn affects the strength of their bones.

The foot and ankle are the most common parts of the body to experience a stress fracture because we are constantly on our feet. Foot and ankle stress fractures often occur in people who begin a new activity that involves any impact of the feet on the ground, such as hiking or running. Stress fractures also occur in people who quickly increase the amount of a certain kind of activity. For example, somebody who normally runs twice a week for 30 minutes who then suddenly begins to run seven days a week for one hour has an increased risk of getting a stress fracture.

Shoes that provide poor support, such as high heels – which place a lot of pressure on the toes – as well as old, stiff shoes can put a person at risk. Finally, people with foot deformities that change their load bearing can develop stress fractures. For example, in a foot with a bunion, the big toe may be repositioned such that stops supporting the weight it should normally should bear. This places more load force on the other toes, which can lead to a stress fracture in one or more of them. In such cases, the second toe (next to the big toe) is the most likely to fracture.

What bones in the foot and ankle are affected by a stress fracture?

Any of the bones of the lower leg, ankle and foot can experience a stress fracture. The most commonly affected bones are:

  • The metatarsals, which connect the toes to the midfoot.
  • The calcaneus (heel bone).
  • The navicular, a bone near the ankle. Navicular stress fractures take a long time to heal.
  • The bones that make up the ankle joint – particularly the tibia and fibula.

Anatomical drawing of the foot, showing the metatarsal and navicular bones. (Illustration by Joseph Yu, BS.)

What are the symptoms of a stress fracture in the foot and ankle?

The key symptom of a stress fracture is pain. Depending on the bone affected, it tends to hurt in very specific, pinpoint areas, and it will hurt when you touch the exact area where the bone is broken.

If you have recently changed or increased your activity and have pain in a specific area of the foot or ankle, you may have a stress fracture. The pain usually becomes more intense when you do impact activities and gets better during periods of rest.

If you think you may have a stress fracture in your foot or ankle, the most important thing to do is to immediately stop all activities that cause pain. If an untreated stress fracture worsens (gets bigger), you will start feeling the pain more quickly during activity that puts stress on the affected bones than when the stress fracture first appeared.

If your pain continues after several days of rest or if your pain goes away but then returns even after several weeks of rest, you should see an orthopedic foot and ankle surgeon (also called an “orthopedist” or “orthopaedist”).

How are stress fractures diagnosed?

Your doctor will first ask you questions about your pain and level of activity to evaluate you for the risk factors discussed above.

Next, he or she will examine you and order X-rays for the area where you experience pain. When a stress fracture is present, it is actually not uncommon for the X-rays to appear normal and show no break in the bone. This is because sometimes the bone reacts and grows new bone to heal the crack. (However, the injured bone is still vulnerable to being rebroken.) When new bone grows, the final step is for it to calcify. A radiologist or orthopedist often confirms the stress fracture diagnosis by seeing the calcification of new bone growth on your X-ray.

In certain cases your doctor may order a bone scan or MRI to provide more information than does a standard X-ray. However, these more expensive tests are not routinely needed to diagnose a stress fracture.

How do you treat a stress fracture?

Most stress fractures will heal on their own if you reduce your level of activity and wear protective footwear for a period of time. As mentioned above, the most important thing to do if you have or think you may have a stress fracture in your foot or ankle, is to cease the activity that caused your problem in the first place. You should stop all high-impact activity for a time, typically for about six weeks.

Icing and elevating the affected leg immediately following a stress fracture can help decrease swelling and pain. As for pain, it is best to take acetaminophen (Tylenol) instead of nonsteroidal anti-inflammatory drugs (NSAIDs), which includes ibuprofen (Advil) and naproxen (Aleve). This is because some data suggests that taking NSAIDs can reduce the ability of bone to heal.

Your orthopedist may recommend that you wear a stiff-soled shoe, a wooden-soled sandal, or a removable “walking boot,” also known as a short leg-fracture brace shoe.

A typical fracture brace or “walking boot” worn to allow a nondisplaced fracture to heal.

How long does it take for a stress fracture to heal?

Many stress fractures of the foot or ankle will heel in 4 to 6 weeks. However, healing times vary, depending on which bone is broken. Some foot bones, such as the navicular or the fifth metatarsal, can take a much longer time to heal than do others.

After weeks of rest, and once the pain is completely gone, you may gradually ease back into physical activity and sports. This gradual reintroduction period should span about 4 to 6 weeks. Switch to a sport that puts less stress on the foot and leg until you have fully recovered. Examples of appropriate low-impact activity include:

  • Swimming
  • Cycling (bicycle riding or spin classes)

The worst choices for resumed activity while you recover from a foot or ankle stress fracture are running or even walking on hard surfaces. You can easily reopen your fracture and have to begin the recovery process again.

During recovery, wear comfortable, supportive shoes without a raised heel. Footwear should be flexible, not stiff. If you are a runner, after you have resumed low-impact activity for 4 to 6 weeks, begin a conservative jogging regimen. Increase your running mileage very slowly over time. Do not do too much, too soon.

Will I need surgery?

Surgery is rarely needed and is recommended usually only after conservative, nonsurgical approaches above are not working.

Preventing stress fractures

The following principles can help you lead a healthy lifestyle and avoid problems with stress fractures:

  • Eat calcium-rich foods and ensure you get enough daily Vitamin D to help maintain bone density.
  • Wear good shoes. Do not wear old or stiff shoes, but instead try comfortable, well-padded, and supportive shoes. It is usually a good idea to wear shoes made specifically for the sport you would like to do. Avoid high heels whenever possible.
  • Do not smoke. This can lead to problems with healing. It is actually the nicotine that creates the problem, so other gum and products containing nicotine will still prevent the bone from healing.
  • Cross-train. This means that you should alternate between activities. For example, you can switch up jogging with swimming or cycling during the week.
  • Slowly ease into previous or new sports activities. Gradually increase the time, speed, and distance. Many experts suggest a 10% increase of exercise time per week.

Updated: 5/31/2019

Authors

Scott J. Ellis, MD

Associate Attending, Orthopaedic Surgery, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Foot fracture – 3 weeks in a boot  · Virtual Fracture Clinic

This information will guide you through the next 6 weeks of your rehabilitation. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery.

 

 

Healing: This injury normally takes 6 weeks to heal.
   
Pain and Swelling: The swelling is often worse at the end of the day and elevating your foot will help. Take pain killers as prescribed.
                                              

Walking:

 

                        

You may walk on the foot as comfort allows but you may find it easier to walk on your heel in the early stages.

The boot you have been given is for your comfort only and is not needed to aid fracture healing but will help to settle your symptoms.

   

Follow up:

 

 

 

 

We do not routinely follow up patients with this type of injury.

If after six weeks you are:

Please do not hesitate to contact us for a further consultation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Picture of bones in the foot

If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice.

Or, if you are experiencing pain or symptoms, other than at the site of the original injury or surrounding area, please get in touch using the telephone or e-mail details at the top of this letter.

 

 

 

 

 

 

 

What to expect

 

  Weeks

  since injury

  Rehabilitation plan

  0-3

  If supplied, wear the boot for comfort and use crutches when walking.

  It is ok to take the boot off at night and when resting at home and to wash.

  Start your exercises straight away to maintain and improve your movement.

  3-6

    X  Try to stop using the boot and to walk without crutches. 

  Start around your house first, then try outside.

  You may want to wear the boot if you go on a longer walk.

  Continue your exercises to regain the flexibility of your foot.

  6 -12

  Your injury is healed. You may have mild symptoms for 3-6 months.

  You can begin to resume normal, day-to-day activities but be guided by any pain you experience.

    X   Heavy tasks or long walks may still cause some discomfort and swelling.

  12 If you are still experiencing significant pain and swelling then please contact the Fracture Care Team for advice.

 

Advice for a new injury

Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin.                                                    

Rest and Elevation: Try to rest the foot for the first 24-72 hours to allow the early stage of healing to begin. Raise your ankle above the level of your hips to reduce swelling. You can use pillows or a stool to keep your foot up

Early movement and exercise: Early movement of the ankle and foot is important to promote circulation and reduce the risk of developing a DVT (blood clot). Follow the exercises below without causing too much pain. This will ensure your ankle and foot do not become too stiff.  These exercises will help the healing process.

Early weight bearing (putting weight through your injured foot) helps increase the speed of healing. Try to walk as normally as possible as this will help with your recovery.

 

Smoking advice

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.

For advice on smoking cessation and local support available, please refer to the following website: http://smokefree.nhs.uk or discuss this with your GP.

 

Boot advice

Diabetic patients: If you are diabetic please contact us to discuss your boot. This is particularly important if you have problems with your skin. We can provide you with a specialist diabetic boot if required.

Footwear for your uninjured foot: We would recommend choosing a supportive shoe or trainer with a firm sole for your uninjured foot. You will notice that the boot you have been given has a thicker sole, by matching this height on the uninjured side you will reduce any stress on your other joints.

 

Exercises

Initial exercises to do 3-4 times a day

Ankle and foot range of movement exercises. Repeat these 10 times each.

  1. Point your foot up and down within a comfortable range of movement.
  2. With your heels together, move your toes apart, as shown in the picture.
  3. Make circles with your foot in one direction and then change direction.

 

Board Certified Foot and Ankle Specialists and Surgeons

A stress fracture is one of the most common overuse injuries related to exercise and sports. Though this condition is typical among athletes, a stress fracture can affect anyone who participates in repetitive or high-impact activities. Almost 50% of all sports injuries are overuse injuries.

A stress fracture in your foot typically occurs as the result of movements that produce repeated strain on an affected bone. In response to the added pressure, the bone develops a tiny, hairline crack, called a stress fracture. Without treatment or modifying your activities to allow the bone to heal, the crack can become deeper over time. 

Early detection and appropriate care are the best ways to prevent a stress fracture from developing into a full broken bone. At Chicagoland Foot and Ankle, our team of board-certified foot and ankle specialists provide professional diagnosis and treatment of stress fractures and other foot injuries, diseases, and conditions. After a thorough physical examination and assessment, your podiatrist determines the extent of your stress fracture and the most appropriate course of treatment for recovery.

Find out how to decide whether your symptoms indicate a potential stress fracture and how you can prevent your condition from worsening.

Physical symptoms of a stress fracture

Stress fractures often affect the weight-bearing bones in your foot, which work to absorb the repetitive stress that occurs during running, jumping, and walking. Common locations include the second and third metatarsal bones, the long thin bones between your toes and ankle, which is where you’re likely to first notice discomfort.

Since the initial signs of a stress fracture may be mild, it’s easy to ignore them or brush them off as an inconvenience. However, the more often you participate in the damaging activity without allowing time for the bone to heal, the more likely it is that the stress fracture can worsen and cause the following symptoms:

  • Pain, aching, and tenderness that worsens during and after physical activity or movement
  • Relief from pain during periods of rest
  • Swelling on the ankle or top of your foot
  • Bruising and swelling at the site of the stress fracture

If you experience any of these symptoms, it’s important to get a medical evaluation to determine proper treatment and reduce the risk of further damage to the affected bone.

How stress fractures occur

Stress fractures don’t occur as the result of an injury or accident, but develop over time. The movements involved in high-impact sports, like running, basketball, tennis, and track and field, involve repetitive activities that are more likely to cause stress fractures.

You may be living with a stress fracture if you’ve made rapid changes in your activities without allowing time for proper conditioning. This can occur when you suddenly increase the frequency or number of days in which you participate in an activity or change from one type of activity to another. 

Using a different exercise surface, like moving from a treadmill to outdoor running, can change the way you put weight on your foot and make you susceptible to stress fractures. Other practices, like using improper equipment or wearing ill-fitting footwear, can exert pressure in areas unable to support repetitive forces. 

Certain physical factors can also increase your risk of developing a stress fracture. Being overweight or having medical conditions like osteoporosis can make your bones more vulnerable to added stress during repetitive movements. 

What to do if you suspect a stress fracture

If you have symptoms common to a stress fracture, it’s important to get an accurate diagnosis as early as possible. An imaging test, such as an X-ray, MRI, or bone scan, is required to accurately diagnose the location and extent of a stress fracture. 

Without proper diagnosis and treatment, a stress fracture can worsen and become a full fracture, causing more intense pain and possible displacement of the affected bone. This can cause long-term damage or the need for surgical correction.

Treatment for a stress fracture usually involves steps to reduce the weight-bearing load on the affected foot. This typically requires allowing your bone time to heal by using the RICE method: rest, ice, compression, and elevation.

Your podiatrist advises the appropriate use of pain medication to reduce discomfort and swelling. You may also have to use a walking boot, brace, or crutches to immobilize the affected bone and promote healing. 

Find out more about stress fractures and whether you may be risking long-term damage by living with this condition. To schedule a consultation with a podiatrist at Chicagoland Foot and Ankle, call our office, or book an appointment at one of our four locations throughout the Chicagoland area. 

Causes, Symptoms, Tests & Treatment

Overview

The bones of the foot.

What is a stress reaction or stress fracture?

A stress reaction can be considered similar to a deep bone bruise, which arises from trauma or overuse. Stress injuries can be classified on a spectrum upon diagnosis: early (stress reaction) or late (stress fracture). A stress reaction that goes untreated will develop into a stress fracture. In a stress fracture, a small crack develops from repetitive trauma, which is usually caused by overuse. Overuse injuries account for almost 50% of all sports injuries.

Where do stress fractures happen?

Stress fractures can occur anywhere there is overuse, but they’re most commonly found in the lower extremity as a result of impact and weight bearing activities. The most common bone is the shin bone or tibia (20% to 75% of all stress fractures — often running injuries). Stress fractures can also occur in the foot. The foot is made up of several small bones. The bones running to the toes are called metatarsals. There are five metatarsals in each foot. It is most common for a stress fracture to happen in the second and third metatarsals. Stress fractures can also be seen in the heel (calcaneus), hip (proximal femur) and even the lower back.

Symptoms and Causes

What causes a stress fracture?

Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic.

Extrinsic factors happen outside of the body. These can also be called environmental (nature) factors. These factors can include:

  • Practicing incorrect training or sport technique.
  • Having too rapid of a training program or volume of activity or changing your activity level without a gradual break-in period.
  • Changing the surface you exercise on, such as going from a soft surface (like an indoor track) to outside on gravel or concrete.
  • Running on a track or road with sloped surface.
  • Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff).
  • Doing repetitive activity in certain high-impact sports, such as:
    • Long-distance running (tibia, hip).
    • Basketball.
    • Tennis.
    • Track and field.
    • Gymnastics (wrist stress fractures from weight bearing on hands/wrists, low back).
    • Dance (feet, low back).
  • Having a poor diet that has inadequate caloric intake for volume of sport.
  • Having a low vitamin D level.
  • Experiencing early specialization in sports. Youth who play one sport year-round without a break are at risk of stress fractures.

Intrinsic factors are things that are related to the athlete or patient and aren’t impacted by outside forces. These factors can include:

  • Age: Older athletes may have underlying bone density issues such as osteoporosis. Already weakened bone will develop a stress reaction and/or fracture sooner than healthy bone.
  • Weight: Both ends of the spectrum seem to be at risk for stress injuries. Someone with a low BMI or underweight individual may have weakened bones and someone with a high BMI doing repetitive loading with their body weight would also be at risk for injuries.
  • Anatomy: Foot problems can affect the way the foot strikes the ground. These foot problems can include bunions, blisters, tendonitis, and low or high arches. Muscle weakness, imbalances or lack of flexibility can also be a factor.
  • Sex: Females may be at risk if they have irregular menstrual periods or no periods.
  • Medical conditions: Osteoporosis or other diseases that weaken bone strength and density (thickness). The weak or soft bones may not be able to handle the changes in activity.

What are the symptoms of a stress fracture?

The symptoms of a stress fracture can include:

  • Pain, swelling or aching at the site of fracture.
  • Tenderness or “pinpoint pain” when touched on the bone.
  • Pain that begins after starting an activity and then resolves with rest.
  • Pain that’s present throughout the activity and does not go away after the activity has ended.
  • Pain which occurs while at rest, during normal activity or with everyday walking.
  • Pain which is worse with hopping on one leg or an inability to shift weight/hop on affected leg/foot.

If a stress fracture is not treated at an early stage (stress reaction), the pain can become severe. There is also a risk that the fracture may become displaced (the fractured bone moves out of normal alignment). Certain stress fractures (hip) are considered “high risk” stress fractures because they may have a poor outcome (such as needing surgery) if not identified early.

Diagnosis and Tests

How is a stress fracture diagnosed?

Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. These tests can include:

  • Physical examination: During your first visit, your doctor will do a physical exam and discuss your risk factors for developing a stress fracture. When discussing risk factors, you will be asked about:
    • Your medical history.
    • Your work.
    • Your activities.
    • Any medications you might be taking.
  • X-Rays: Your doctor may order an X-Ray to look for a fracture. However, a stress fracture can be difficult to see on an X-Ray because the bone often appears normal and the small cracks can’t be seen on the image. X-rays actually miss about ⅔ of stress fractures. X-Rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-Rays. With a high index of suspicion for a stress fracture, your doctor may recommend an imaging test that is more sensitive than an X-Ray and will pick up a stress reaction even before it may become a stress fracture. These tests can include:
    • Magnetic resonance imaging (MRI).
    • Bone Scan.
  • Bone scan: A bone scan may be used to see stress fractures that cannot be seen on an X-Ray. During a bone scan, a tracer (a radioactive substance) is injected into your bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan that an uninjured area.
  • Magnetic resonance imaging (MRI): When your doctor needs very detailed images of the injury, an MRI may be used. Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio waves and a computer to produce very clear images of the human body. An MRI is preferred in many cases because:
    • There is no radiation exposure.
    • It takes less time than other imaging tests.
    • It is better at diagnosing different types of bone and or soft tissue problem.

Management and Treatment

Do I need to treat a stress fracture?

Yes, you need to treat a stress fracture. If you think you have a stress fracture, the first thing to do is rest. Stop any activities which may be contributing to the injury. Schedule an appointment and see your doctor. It’s important to follow the treatment guidelines he or she gives you to prevent further injury.

If a stress fracture is not treated, the fracture may get worse. It can heal improperly, lead to arthritis or may even need surgery. Definitely do not ignore the pain. Ignoring the pain can lead to serious problems in the future, so it is important to see your doctor when you start feeling the pain.

If you have an underlying medical condition like diabetes or neuropathy, it is very important to see your doctor if you are experiencing any pain with your legs, ankles or feet.

How is a stress fracture treated?

Stress fractures are treated in several ways. Your doctor will discuss your options based on the location and severity of your fracture. Also, your provider will aim to treat any risk factors you have for future injuries.

Treatments your doctor may recommend can include:

  • Stopping the activity that is causing pain. Stress fractures happen because of repetitive stress and overuse, so it’s important to avoid the activity that led to the fracture.
  • Applying an ice pack (10 minutes) or ice massage (ice cube rub for three to five minutes) to the injured area.
  • Resting for roughly two to eight weeks.
  • Cross training by doing non-impact exercise (like a using a pool or bike) after discussion with your doctor may be allowed. Eventually, once you can perform low-impact activities for extended periods without pain, you can start doing high-impact exercises. Often, physical therapy can be very helpful in returning to activities and making adjustments to avoid reinjury.
  • Adjusting your position if there is swelling in your leg, ankle or foot. You can lessen the swelling by elevating your leg — raising your foot above the level of your heart — while you’re lying on your back.
  • Taking nonsteroidal anti-inflammatory medicines to help relieve pain and swelling.
  • Using protective footwear to reduce stress on your foot or leg. This may be stiff-soled shoe, a wooden-soled sandal, or a post-op shoe which has a rigid sole.
  • Using crutches to keep weight off your foot or leg until the bone heals.

Will I need a cast if I have a stress fracture?

Your doctor may need to put a cast or fracture boot on your foot to keep the bones in a fixed position. Using a cast or boot help remove the stress on the leg and promote healing.

Do you ever need surgery for a stress fracture?

Some stress fractures need surgery to heal properly. This is called internal fixation. Depending on the location of fracture, the surgeon may use pins, screws or metal plates.

How should I modify my activities when recovering from a stress fracture?

When you are recovering from a stress fracture, it is important to follow your doctor’s instructions. Ignoring your recovery plan and returning to your full activities too quickly can lead to more severe injuries in the future. There are two things to remember when you are starting to exercise again:

  • Take it slowly.
  • Introduce activities that place less stress on the injury.

During the early phase of healing, the doctor may recommend that you change your schedule so that you rest one day, do an activity the next day and then rest the next day. An example of this schedule is:

  • Rest one day.
  • Do an activity the next day.
  • Rest the next day.

Alternating your activity and rest days allow your body to ease back into fitness. You should slowly increase how often and how vigorously you exercise. If the activity that caused the stress fracture is started too quickly, you may develop a larger fracture that is harder to heal. If you re-injure the bone, it can lead to long-term problems, and the stress fracture might never heal properly.

Prevention

How can a stress fracture be prevented?

These steps can help prevent a stress fracture:

  • Once you feel pain, stop exercising. Only return to exercise if you are pain-free.
  • See your doctor as soon as possible if you have a persistent area of concern or discomfort.
  • Use the correct sports equipment.
  • Wear the proper running shoes. Running shoes should be replaced every 300 miles.
  • Add new physical activities (for example, switch running with swimming).
  • Start new sports activities slowly and gradually increase the time, speed and distance.
    • When restarting a sport or activity, reduce your intensity by 50%. Follow the 10% rule — no increases of more than 10% per week.
  • Make sure to properly warm up and cool down before activities.
  • Practice strength training to help prevent early muscle fatigue, and to help prevent the loss of bone density that comes with aging.
  • Follow a healthy diet full of calcium and vitamin D foods that will keep your bones strong. A sports nutritionist can be helpful if you are extremely active and have a history of stress fractures.
  • If you decide to increase your activity level, ask your doctor for a recommendation of how much to add and when to add it.
  • Optimize your bone health. If you have a known history of osteopenia or osteoporosis, discuss with your doctor how to medically manage these conditions. For an active person, treatment is best before an injury occurs. A stress fracture with a weak bone is harder to heal.
  • If pain or swelling returns, stop the activity and rest for a few days. If pain continues, see your doctor.
  • Check with your doctor before starting an exercise program or before taking a job that will involve a higher level of physical activity than you are used to.
  • Follow all the rules your doctor gives you.

Outlook / Prognosis

How long does it take to recover from a stress fracture?

As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. It takes roughly six to eight weeks for a stress fracture to heal, so it is important to stop the activities that caused the stress fracture. Always ask your doctor before you fully return back to exercise to make sure the area is healed and you are ready to go.

Orthopaedic Urgent Care, Sports Medicine & Wellness Clinics

If you love sports and play your sport frequently, you’re susceptible to stress fractures in your feet and lower legs. A stress fracture, sometimes called a hairline fracture, is a tiny fissure in a bone. 

Urgently Ortho in Scottsdale, Arizona, specializes in treating all types of orthopedic injuries, including stress fractures. Our team includes a board-certified orthopedic surgeon, a physician specializing in pain management, and a doctor trained in regenerative medicine. 

What are the signs of a stress fracture? 

You may have a number of symptoms from a stress fracture. 

Pain

You likely feel a dull ache where the fracture is located. The pain intensifies when you’re on your feet and lessens or goes away when you’re resting. Over half of stress fractures are in the lower leg/ankle. If the fracture has gone untreated for a while, you feel significant pain when you bear any weight on the foot. 

Swelling

The site of the injury, whether it’s the foot, ankle, or leg, is likely swollen. 

Tenderness

Is your foot tender when you touch it, especially in one place? Your finger is probably resting on or near the cracked bone. 

Bruising 

Blood rushes to the injured site, so your foot or ankle may look purple or blue. 

Weakness

Your foot may not feel as sturdy when you’re on it. You notice that you’re not able to operate at the top of your game. You’re probably favoring the injured foot by bearing less weight on it or walking on the outside or inside of your foot to avoid pain. 

How did I get a stress fracture?

Any sport in which your feet hit the ground repeatedly from running, jumping, and pivoting quickly, such as basketball, track and field, tennis, and gymnastics, can lead to stress fractures. 

These fractures are typically overuse injuries. Perhaps you’ve been in a three-day tennis tournament. Your muscles are overworked, and the stress transfers to the bone, leaving a small crack. 

You can also get a stress fracture from suddenly increasing the amount of time you play your sport after having been sedentary — for instance, returning to the court for rigorous play after you’ve been sick. It’s important to take time to ramp up your level of activity after being out of action for a while. Perhaps you’re running on worn-out shoes: Lack of the right equipment can lead to a stress fracture as well.   

Treating a stress fracture 

Your physician at Urgently Ortho reviews your medical history, physically examines the painful area, and conducts imaging tests to diagnose your condition. 

The first line of defense when you have a stress fracture is using the RICE method to help heal it: rest, ice, compression, and elevation. Over-the-counter pain relievers also help reduce pain and inflammation. 

Your Urgently Ortho physician determines whether you need a cast to hold the bones in place during the healing process. Your doctor may prescribe a walking boot to reduce stress on the affected area, or you may need crutches if your physician wants you to avoid weight-bearing for a period of time. She may also recommend custom orthotics to provide extra support to the injured area and your entire foot. Untreated stress fractures may lead to the need for surgical repair, so it’s important to seek treatment promptly. 

Contact Urgently Ortho right away if you believe you have a stress fracture and for any orthopedic need.

Causes and Prevention of Stress Fractures in the Foot and Ankle

Stress.

I’m sure that word has been included in all of our daily used vocabulary during these incredibly, well, for lack of a better word, stressful times. However, stress isn’t solely a pressure put on our mental health from life’s rollercoaster of events.

Our bones can be put under unnecessarily high levels of stress from overuse and repetitive activity, leading to small cracks called stress fractures. This unfortunate reality is especially true for the bones within our feet and ankles that we heavily rely on every single day.

“The foot and ankle are extremely vulnerable to stress fractures,” explains Gautham Gondi, MD, a foot and ankle surgery specialist. “The foot and ankle consist of weight-bearing bones that absorb the repetitive force of activities we do every day such as walking, running. and jumping.”

What exactly is a stress fracture?

A stress fracture is an overuse injury that often occurs in the following areas of the foot and ankle:

  • Second and third metatarsal: the long bones of your feet that connect the ankle to the toes.
  • Fibula: the outside bone of the leg.
  • Talus: the small bone that sits in between the heel and leg bones.

Extremely common in runners and athletes who participate in running sports like soccer or basketball, stress fractures develop over time as the result of repetitive force being placed upon the bone. The repetitive force is repeated so frequently that our bones and surrounding muscles do not have adequate time to heal.

The force isn’t quite strong enough to cause an acute fracture such as a broken ankle, but it does cause microscopic damage to the bone.  As Peter White, MD, who also specializes in foot and ankle surgery, states, “Our bones are in a constant state of developing new bone to replace older bone called remodeling. If our activity levels are too high on a specific bone area such as the foot or ankle, the breakdown of older bone accelerates. Therefore, our body’s ability to repair and replace it can’t catch up. The bone then weakens and is highly vulnerable to stress fractures.”

What causes a stress fracture?

Increase in physical activity

  • Most common cause is an abrupt increase in physical activity levels.
  • Can be frequency (i.e. number of days you work out in a week) or duration/intensity of workouts (i.e. training for an hour rather than training for 30 minutes).
  • Not pacing yourself when beginning a new workout routine, especially if you are not already in shape.
  • Combination of increasing activity, pushing through discomfort, and not giving your body ample time to rest often leads to stress fractures.

Poor technique

  • Altering the mechanics of how your foot absorbs the force of your foot hitting the ground can increase you risk for a stress fracture.
  • Blisters, bunions, tendonitis can cause you to shift your weight onto an area of your foot not made for force absorption.
  • An area of bone in the foot may be forced to handle more weight and pressure than usual.

Improper equipment

  • Shoes that are worn and flimsy lose their shock absorption capabilities.
  • Wearing them while walking, working out, or running can increase your risk for a stress fracture.
  • Running shoes have a 300 mile lifespan and should not be older than 3 months.

Change in surface

  • A change to a harder surface than you typically exercise on can raise the chances of you developing stress fractures.
  • Examples of these changes are moving from running on a treadmill to running on pavement, playing basketball on a hardwood floor to playing on a concrete court, and playing tennis on a grass court to playing on a hard court.

What is the treatment for a stress fracture?

Non-surgical treatment

  • Rest, ice, compression, and elevation known as the RICE protocol combined with over-the-counter ant-inflammatory medication can significantly reduce symptoms.
  • Your doctor may recommend using crutches to keep weight off the foot and/or ankle.
  • Your doctor might also recommend wearing protective footwear such as a walking boot.
  • Stress fractures typically take 4-6 weeks to heal. You must modify your activities during that time. For exercise, swimming and cycling are excellent alternatives.

If the above treatments are not enough, surgical treatment may be required for the bone to heal. Performing a procedure called internal fixation, your doctor will support the foot or ankle using pins, screws, and/or plates.

How can I prevent stress fractures?

  • Whether you are just beginning to work out or are just changing to a new type of workout, start the new activity slowly. Pace yourself.
  • Use proper equipment. Remember that shoes have a lifespan of 300 miles and should not be older than 3 months. Write on the heel of the shoe in sharpie the date you purchased them.
  • Cross train. Change up your workout routine to avoid over stressing one specific area of the body. For example, do cardio one day; do upper body the next; do core strengthening the next; etc.
  • Stop activity if pain or swelling returns to your foot and ankle.
  • Eat a balanced and healthy diet that contains plenty of calcium and vitamin D to support bone strength.

When thinking about what might have caused a stress fracture in our foot or ankle, many of us only attribute exercise as the culprit. Yet, as foot and ankle specialist Paul Switaj, MD, states, “Every daily step counts too. You must remember that walking to and from the kitchen or up and down the stairs numerous times a day adds up and places stress on the bones of your feet and ankles.”

With many of us working from home, it is likely that we are walking barefoot on hardwood floors for extended periods of time. So, while it might feel as though our activity levels are not as high when we are confined to our homes, the stress levels placed on our bodies still remain. Therefore, we must keep these prevention methods in mind when exercising and during the daily routines of our lives.   

Stress Fracture in Foot | Stress Fracture Symptoms and Treatment

  • Common causes of stress fractures include overuse or ramping up your mileage too quickly.
  • While a stress fracture is healing, you should stay off the bone and give the injury time to heal.
  • During recovery, you can still exercise by doing low-impact cross-training, such as swimming or biking, with clearance from your doctor.

    It can happen in an instant, and it usually starts with a flinch—something that doesn’t feel right—then a sinking feeling in your stomach, and a hope that it’s nothing serious.

    But sometimes (and all too often for runners) the result is a stress fracture in your foot. Runners most often get stress fractures in the foot or lower leg. These can be caused by too much loading force on the bone. One way this happens is when you tack on too many miles too quickly, and with so many new runners taking up the sport it’s easy to crank up your mileage before your body is ready to handle it.

    If you suspect a stress fracture in your foot or other parts of your body such as your shins, knees, or hips, take a break from training and check in with your doctor. Here, Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City, breaks down everything you need to know about stress fractures.

    What Is a Stress Fracture?

    A stress fracture is a tiny crack in the surface of a bone, usually in the lower leg or the metatarsals of the foot for runners. Stress fractures often occur when we increase the intensity and volume of our training over several weeks to several months. Muscle soreness and stiffness can progress during this period, and a pinpoint pain may develop in the area of the sore bone.

    Stress fractures start as a stress reaction. “A stress reaction or a stress injury happens when the bone starts to swell inside,” says Metzl, creator of Runner’s World’s IronStrength workout (available in the All Out Studio app). “The worse the symptoms get and the more you don’t pay attention to them, the more likely you are to turn a stress reaction or stress injury into a full-blown stress fracture.”

    If you suspect you may have a fracture, see a doctor or podiatrist immediately, as further running will only worsen the issue . “Like almost every overuse injury, the worse the symptoms get and the more you try to run through the pain, the worse you’ll make this injury,” says Metzl.


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    Identifying Stress Fracture Symptoms

    Runners typically get stress fractures in their feet, shins, knees, and hips. And according to Metzl, there are three main ways to identify one at home: point tenderness, swelling, and changes in your typical running form.

    If you experience point tenderness—when a specific bone is sore to the touch—that could signal a stress fracture. If you suspect a stress fracture in your foot, performing what’s called “the hop test” is a good way to figure out if you have point tenderness. Carefully, hop a couple of times on the injured foot. If you have pain when you land, it could be a stress fracture.

    Swelling in the affected area is another common sign. While you could see swelling anywhere, the most common place people experience noticeable swelling is on the top of foot due to a stress reaction or fracture in the metatarsals. Metzl notes that you may lose the contour of the veins on the top of the foot when you compare one foot to the other.

    Changes in your biomechanics while running could also be a sign of a stress fracture. So if you’re in so much pain that you need to adjust your form, consult your doctor right away. “If you notice you’re not landing on your foot the same way you usually do because it hurts too much, get it checked out,” Metzl says.

    In the end, a stress fracture is a clinical diagnosis injury meaning that your doctor can tell you if you have one with some simple tests. So if you expect you might have one, skip the at-home stuff and just head in to your doctor’s office to be sure.

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    Common Causes of Stress Fractures

    There are a few things that could lead to a stress fracture, and most are related to putting too much loading force on your bones. The first is ramping up your mileage too quickly. “Bone needs time to get used to the more loading force of running, so make sure you give your bones enough time,” Metzl says.

    People who overpronate are more prone to stress fractures because they put a lot more medial loading force on their legs. Having osteopenia (lower than average bone density) or osteoporosis (much lower than average bone density) can also cause stress fractures. Both genetics or not getting enough calcium in your diet can cause these two issues. Your doctor may order a bone density test to determine if you are at risk.

    What’s more, a pair of studies from Thomas Jefferson University in Philadelphia sought to identify overlooked physiological factors and lack of knowledge that contribute to stress fractures in women who run. They found that those who increased their training load more quickly and those who didn’t pay much attention to nutrition and strength training were more likely to suffer a stress fracture than those who did pay attention to these factors.

    Stress Fracture Treatment

    Upon suspecting you have a stress fracture, treat the area with ice and take a recommended dose of anti-inflammatories, but keep in mind that stress fractures are not a self-diagnosis or self-treatment type of injury. A proper X-ray or bone scan is necessary to prescribe treatment and depending on the location of the fracture, recommendations may differ, so consult your doctor immediately.

    Some stress fractures won’t show up on an X-ray, so MRIs are typically done to definitively diagnose a stress fracture because they can detect both stress reactions and stress fractures. (An X-ray can only detect severe or already-healing stress fractures.)

    Once you’ve been diagnosed, you’ll mainly want to stay off of the bone and give the bone enough time to heal. One thing Metzl notes is that stress fractures farther away from your heart heal slower because they receive less blood flow.

    However, just because you have a stress fracture doesn’t mean you can’t still exercise. You can still keep your cardiovascular fitness going by cross-training. Metzl recommends low-impact activities such as cycling or swimming, but talk with your doctor to discuss the activities you should and shouldn’t be doing as your stress fracture heals.

    Stress Fracture Prevention

    First and foremost, Metzl advises adding mileage to your long runs gradually to prevent injuries. If you haven’t run more than four or five miles in few months, don’t suddenly jump up to a 20-mile long run without working up to it first. Experts recommend increasing your weekly mileage by no more than 10 percent each week.

    Metzl also recommends shortening your running stride and quickening your cadence. A stride of 80 to 90 steps per minute with your right foot (160 to 180 with both feet) can decrease your chance of injury.

    Finally, make sure you get enough calcium in your diet to prevent osteopenia or osteoporosis. Adult runners should aim for 1,000 milligrams of calcium per day, and a good source of calcium should have at least 100 milligrams per serving. Foods such as yogurt, milk, cheese, tofu, and dark, leafy greens are all great options.

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    Fracture of the leg | EMC

    Fracture is a bone injury with a violation of its integrity. A leg fracture can occur as a result of a fall, a strong impact, overuse, and affect any part of the lower limb.

    In case of a fracture or suspicion of a fracture, it is necessary to immediately consult a doctor in order to start treatment on time, to avoid possible complications and to shorten the recovery period.

    Types of fractures

    By the nature of the location of the fragments, fractures with and without displacement are distinguished.The type of displacement depends on the direction of the traumatic force, as well as the traction of the muscles that are attached to a particular site of the bone.

    In addition, there are closed and open fractures. With a closed fracture, the integrity of the skin is not violated, while an open fracture is accompanied by skin damage and the formation of an open wound. In almost all cases, an open fracture requires urgent surgical intervention.

    In addition, there are simple (the formation of 2 bone fragments), comminuted (the formation of 3 or more bone fragments) and multiple (fracture of different bones on one limb) fractures.

    Causes of fractures:

    Fracture symptoms:

    • severe pain in the area of ​​injury;

    • limitation of movement in adjacent joints;

    • sometimes visible deformity of the bone;

    • inability to step on the foot;

    Swelling often occurs after a fracture.This is due to impaired blood flow in the area of ​​injury, however, sometimes damage to muscle tissue can also be the cause. Edema can occur both immediately after injury and long after it.

    Diagnostics

    A preliminary diagnosis can be established during a clinical examination by a specialist of the site of injury, however, to clarify the diagnosis, it is necessary to conduct an X-ray study, which allows you to determine the exact location and nature of the fracture.If the fracture line passes through the joint, a CT scan is needed.

    The round-the-clock diagnostic department of the European Clinic of Sports Traumatology and Orthopedics (ECSTO) is equipped with the most modern equipment that allows you to accurately and quickly diagnose and immediately begin treatment.

    Treatment of leg fracture

    Depending on the nature, type of fracture and age of the patient, conservative or surgical treatment is used.In the first case, the injured limb is immobilized with a longitudinal bandage until the edema subsides, then a final plaster or plastic (polymer) bandage is applied.

    The duration of the final dressing depends on many factors, including the location and severity of the fracture, and can range from 1 to 4 months

    Treatment of fractures with a surgical method (osteosynthesis) is carried out, as a rule, in complex cases (open, comminuted fractures, fractures with displacement). Fractures without displacement are also operated if there is a high risk of its occurrence.To fix the fragments, various metal structures (plates, pins) are used, which allow the bone to be fixed in the correct anatomical position, not to use external immobilization, and to start early rehabilitation. After fusion (healing) of the fracture, metal fixators in most cases do not require removal, but sometimes they can be removed for medical reasons or at the request of the patient.

    Rehabilitation after a broken leg

    If swelling occurs after removing the final dressing, the doctor may recommend the use of ointments, physiotherapy, and therapeutic exercises.We do not recommend trying to get rid of edema using folk methods. Competent treatment, suitable in a particular case, can only be prescribed by a qualified specialist.

    Fracture recovery can be done at the ECSTO Rehabilitation Department. Here is a full range of procedures, techniques and devices that allow the patient to return to their normal life in the shortest possible time.

    As a rule, the recovery time after a fracture of the lower limb ranges from one to several months.

    90,000 reasons how they are treated in Irkutsk at the Expert Clinic

    Flat feet in adults may be congenital. Some people are seen by an orthopedist since childhood. But the problem can appear over the years. How to treat flat feet in adults and can it be corrected at all? We asked these and other questions to Dmitry Alexandrovich Shobogorov, a traumatologist-orthopedist of the Expert Clinic Irkutsk.

    – Dmitry Alexandrovich, what is flat feet? What is the problem?

    – Flat feet is a deformity of the foot.It is of two types: transverse and longitudinal. With longitudinal flat feet, the inner part of the foot begins to fall and even touch the floor. Other people from the outside can notice this, that is, it is clear that the foot is spread out. Not everyone can see the transverse flat feet. It usually becomes noticeable only with secondary signs when hallux valgus occurs. This is the so-called growing lump on the joint and the curvature of the first toe (it starts to stick out to the side).

    The longitudinal arch on the inner side and the transverse arch form an arched structure of the foot, which provides shock absorption when running and walking. With the help of such a structure, the foot moves smoothly: it switches to a walk, to a step, to a run, and at the same time the joints are not injured. Therefore, when flat feet are formed, joint trauma can increase. The biomechanics of walking, the work of the muscles of the lower leg and foot are impaired.

    By evolution, the foot is not designed to constantly walk on a hard, flat surface.Today many houses have parquet flooring, concrete and asphalt on the street, that is, everywhere there is a flat solid surface. And the foot, which for thousands of years has been accustomed to walking on sand, earth, stones, constantly adapting to some changes, now adapts to a flat surface, spreading out on it. In addition, in recent centuries, the way of life has changed: people have become less mobile, including in the workplace; high-heeled footwear began to be produced; labor appeared that can chronically injure the foot.

    – How common is flat feet in adults?

    – As a rule, out of four people who come to see me, three have flat feet of varying severity. I see my feet almost every day, check them for flat feet, make individual orthopedic insoles myself, and I probably meet the perfect foot, with which nothing needs to be done in terms of orthopedics, probably once a month.

    – What are the reasons for the development of flat feet in adults?

    – Flat feet, which can be traced from childhood, are usually congenital and can be transmitted from parents, grandparents.There are people who are seen by an orthopedist since childhood, are treated, and this problem grows with them.

    Standing work, for example, can lead to flat feet in adulthood. Teachers, salespeople, by virtue of their profession, stand on their feet for many hours a day for decades, and the foot begins to deform and flatten.

    Another reason is hormonal changes in women (flat feet, as a rule, are more common in them). This is, firstly, the stage of growing up, then pregnancy, childbirth.Some women become pregnant and give birth multiple times during their life. In this case, in particular, there is a restructuring of the connective tissue. That is, the body prepares for childbirth, then returns, let’s say, to its previous state, and then again prepares for childbirth. The connective tissue begins to change: it stretches, then it becomes strong again. At the same moment, changes in the foot are included. All this also affects the work of the muscles.

    The third reason is fractures and other injuries of the foot, heel or bones in the ankle joint.They can also lead to flat feet.

    – How to recognize flat feet in adults? What signs indicate a problem?

    – Signs of flat feet in an adult are leg fatigue, swelling in the legs, pulling pain in the feet, varicose veins on the lower extremities, hallux valgus, that is, the legs, knees seem to be drawn inward. In addition, the foot itself is piled inward, that is, it is clear that the person seems to be walking on the inside of the foot.Because of this, the shoe can be erased (the heel or heel on the inside, or the place under the first toe), or the insole, which is in the shoe, can be pressed through.

    – Dmitry Alexandrovich, how is flat feet diagnosed?

    – The first is inspection. A person is examined from the front and from behind, and how he stands is assessed. Check the mobility in the fingers, in the small joints of the foot. At the same time, they find out what could be the cause of flat feet, deformity of the foot. For example, the examination can reveal the rigidity (stiffness) of the joint, the consequences of the trauma suffered.An examination of the footprint (that part of the foot that touches the surface) is carried out on a plantoscope. With the help of plantography, the force of pressure of the foot on the surface is measured.

    X-rays can be taken with or without stress. In this way, in particular, the spring function of the foot is checked.

    – What are the ways of treating this pathology? Is it possible to cure flat feet in adults?

    – There are several methods of treatment and it is recommended to use them in a complex manner.The first is orthopedic insoles. It is desirable, of course, individual, matched taking into account the changes in the left and right foot.

    The second is manual therapy. It will allow you to tone up certain muscles, relieve increased tone (hypertonicity) from the muscles that take on part of the load. That is, this treatment will help normalize the function of muscles, ligaments, tendons.

    The third point is physiotherapy exercises. There is a certain set of exercises in which the muscles and tendons that are responsible for the arches of the foot are involved.These muscles and tendons need to be trained daily.

    If there is excess weight, it must be reduced in order to reduce the load on the feet. If flat feet are associated with standing work, you should try to pause. The teacher, for example, during recess, can do the exercises that are necessary to stimulate the tone of the muscles and tendons responsible for the arches of the foot.

    If you follow all the recommendations, then flat feet can be cured, but this is not easy.

    – Are folk remedies used to treat flat feet in adults? If so, which ones?

    – As a rule, this is walking on pebbles, shifting pencils, markers with toes, walking on tiptoe and in single file.However, I don’t even know if this can be attributed to folk remedies or not. These are all exercises that were performed back in Soviet times in kindergartens and schools. If you mean whether a burdock or a cabbage leaf is applied to the feet, then no, this is not done. Flat feet cannot be treated with such means.

    – Why are flat feet dangerous in adults? What can be the consequences if it is not treated?

    – It can be chronic venous insufficiency (varicose veins), edema in the legs.Pain, cramps, deformation of the forefoot, when the toes begin to bend, may be troubling. The first toe (thumb) begins to move to the side, calcification appears on the feet (the so-called corns). Sometimes it happens that people go to a pedicure master for a long time or try to steam it off, cut out these corns, or go to a dermatologist, thinking that it is a wart. But in fact, this is simply a compensatory corns in the place where it should not be. And you just need to go to the orthopedist.

    When the foot is flattened, a person’s height may also decrease. In addition, the likelihood of injury increases: the sensitivity of the fingers decreases, the legs twist when walking, and you can get not only sprains and sprains, but also fractures.

    – Dmitry Alexandrovich, tell us what needs to be done so that this ailment bypasses a person?

    – There are a number of exercises you can do. It is useful to walk on the heels, on the outside of the feet, in single file on socks, to collect pebbles, pencils or felt-tip pens from the floor with your toes, roll a hard ball with your feet (as an element of self-massage).

    It’s also important to choose the right footwear. You should try to wear shoes with high heels and without heels (ballet flats, moccasins, etc.) less often. It is recommended to wear shoes so that the heel and toe differ in height. The heel area should be three to four centimeters (up to five) above the toe.

    If you constantly go to the pedicure master with some problem (the nail often comes off or turns blue, the toe aches, the legs get tired), contact the orthopedist. Perhaps the reason is not because you are wearing uncomfortable shoes, but because of flat feet.

    To make an appointment with a traumatologist-orthopedist at Clinic Expert Irkutsk, you can here

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    For information:

    Shobogorov Dmitry Alexandrovich

    Graduated from Irkutsk State Medical University in 2011, and in 2013.- residency in traumatology and orthopedics.
    Performs all types of arthroscopic operations, treats arthrosis of large joints of the upper and lower extremities, performs corrective osteotomy for deformities of the feet and lower extremities.
    At present, he is a traumatologist-orthopedist at the Expert Clinic, Irkutsk. Accepts at the address: st. Kozhova, 9 A.

    Fractures of the vertebral bodies / ConsultantPlus

    This is the most common fracture in osteoporosis and, unfortunately, is not always “noticed”.Treatment of vertebral fractures is usually conservative and rarely requires surgery. To create conditions conducive to fracture healing, it is necessary to monitor posture and strive to keep the spine in a neutral position.

    Neutral position

    The spine can be thought of as a tower of bone blocks stacked on top of each other and fixed to each other, like LEGO bricks. Each of the 24 vertebrae has a specific shape and size. When they are all stacked on top of each other, they form three natural little curves.This position is called neutral.

    Getting out of bed

    – Try to keep your spine in a straightened position – for this, imagine that it is a metal rod;

    – Lower your legs down, in parallel with this, rest your hands on the bed to raise your torso;

    – Try to sit on the bed as high as possible;

    – It is convenient if you have a walker near the bed, which you can hold on to with your hands. If there is no walker, place a high-backed chair;

    – When assuming an upright position, hold onto a chair or walker;

    “Going to bed”

    When going to bed, do the opposite:

    – Sit on the edge of the bed

    – Slowly lower yourself to the side and stretch your legs on the bed

    – Straighten your spine, gently roll onto your back

    – Turn your head and then your hips and shoulders as a single unit

    Walking

    After a vertebral fracture, it is recommended to walk / stand more and sit less.Try to get out of bed at least every hour and walk for a few minutes. In this case, you need to straighten the spine as much as possible. You need to sit with your back straight, for this use a chair with a high back and a firm seat, the spine should be pressed as tightly as possible against the back of the chair.

    In the car

    Fastening the seat belt requires rotation of the torso. Severe twisting increases the risk of re-fracture. Try to stretch your spine as much as possible and perform movements in conjunction with your hips.It is recommended to use a wedge pillow in the car, which will make it easier to get out of the car.

    Bends while maintaining a neutral back position

    When leaning forward, use the so-called “loop position” between the spine and the hip.

    This significantly reduces the load on the spine and reduces the risk of recurrent fractures. To get into the correct position, bend your knees, keeping your back straight. At first, after a fracture, it is uncomfortable, however, then you will notice how the load on the spine decreases.Look in the mirror to make sure you are doing the bends correctly.

    Corsets and orthoses

    It is necessary to wear a corset from the first day after the fracture of the vertebral bodies. The main task of the corset in osteoporosis is to increase the intra-abdominal pressure, thereby reducing the load on the spine.

    It is not recommended to use massive and rigid corsets.

    Even with a fracture in the thoracic spine, it is possible to wear semi-rigid lumbar corsets.Thoracolumbar corsets can also be used.

    It is recommended to walk and wear a corset from the first days after the fracture.

    ATTENTION !!!

    In case of fractures of the vertebral bodies or large loss of bone tissue, the corset is worn all day, its use can be prolonged, since modern designs do not contribute to atrophy of the back and abdominal muscles.

    6 – 8 weeks after the fracture, you can start exercises to strengthen the muscles of the back under the supervision of an exercise therapy doctor.At the same time, increase the periods of activity and reduce the time of rest.

    Physiotherapy for vertebral fractures

    – Starts under the supervision of a physician.

    – Exercises are aimed at strengthening the back muscles. The exercises are performed in the supine position, with a pillow under the head if necessary.

    – Bend the legs at the knee joints to 90 degrees.

    Returning to everyday life

    It is necessary to remember the basic rules:

    – keep the spine in a neutral position;

    – walk and stand more, sit less;

    – walk with your head up;

    – use “loop position” for inclinations;

    – do not lift more than 3 kg;

    – do exercises while lying on your back.

    Fracture-dislocations in the ankle joint (ankle) – symptoms, first aid and treatment, rehabilitation – Traumatology Department of the Central Clinical Hospital of the Russian Academy of Sciences

    Fracture-dislocations in the ankle joint and open fractures are complex intra-articular disorders that are characterized by extensive damage to soft tissues and bones, ligament rupture, dislocations and subluxations of the foot. Hidden ankle fractures are the result of trauma:

    • A blow to the joint;
    • Crushed by parts of mechanisms.

    The fracture can be open or closed, with or without displacement.

    • Falling from stairs or during sports activities may result in a displacement fracture.
    • When jumping or falling from a height, perforation of the skin with bone fragments is possible.

    Symptoms of fracture

    • Difficulty walking;
    • Inability to lean on the leg;
    • Severe pain;
    • Edema in the area of ​​injury;
    • In case of dislocation, it is possible to lean on the leg.

    Diagnostics and first aid

    The doctor examines the injury and orders an X-ray examination in two projections. If this measure is insufficient, CT is prescribed.

    With a closed fracture, a splint is applied and the victim is given an anesthetic. When open, a tourniquet and an aseptic bandage are applied. It is forbidden to set the bones on their own. This work is performed by a traumatologist.

    Treatment

    Ankle fractures are treated by repositioning the joint and restoring its functionality.If this is not done, the consequence of the trauma is the development of arthrosis.

    If accurate reduction is not carried out, then complete recovery is impossible, the patient will have constant aching pain. With a strong displacement and the absence of qualified assistance, disability develops.

    Two methods of treatment are used

    1. Conservative – manual reduction of bones. If necessary, a limb brace is applied using a plaster cast with further correction.
    2. Operational, using osteosynthesis – wires and metal joints are applied to the damaged bones. The patient wears a cast for up to 1.5 months.

    After treatment, patients will have a long recovery.

    Which doctor should I go to for diagnosis?

    Ankle fracture is treated in Moscow, in the clinic of the Russian Academy of Sciences. Highly qualified specialists will conduct an examination and diagnostics, take all the necessary measures for effective treatment and provide measures to fully restore the functionality of the joint.An appointment with a traumatologist orthopedist is made on the website and at the specified phone number.

    90,000 Surgical fixation methods for the treatment of tibial plateau fractures (fractures of the upper end of the leg bone) in adults

    What is the nature of the medical problem?

    Tibial plateau fractures are damage to the upper end of the tibia (lower leg bone) that forms the lower surface of the knee joint. These fractures are often accompanied by significant damage to the skin and muscles and can lead to voids or defects in the bone.

    What treatments are available?

    Often, the surgical treatment of complex fractures consists of open repair and internal fixation (ORIF), which involves providing direct visibility of the fracture and then securing the bone fragments with plates and screws. Another method is external fixation, in which wires and pins are placed in the bone around the fracture site to anchor the fragments before they fuse. Together with external fixation, it is possible to use small plates or screws to hold some of the fracture fragments in place; this is called hybrid commit.

    To correct possible bone defects, both grafts taken from the patients themselves and bone substitutes can be used as fillers.

    What evidence is available?

    In September 2014, we found 6 small studies (429 adults) on various fixation techniques and bone fillers. All 6 studies were small, with significant risk of bias. We rated the quality of most of the available evidence as very low, which means that we are very uncertain about these results.

    Three studies evaluated different fixation techniques. One study found that hybrid fixation was more likely than standard ORIF to improve quality of life and lower limb function; reducing the number of complications requiring surgery, and returning people to the level of activity before injury, however, the possibility of a better result from ORIF could not be ruled out. In another study, the minimally invasive technique, using one plate, was compared with the traditional open technique, which uses two plates.In this study, only very small differences were found between the 2 groups regarding knee function, complications, or reoperations. In a third study, arthroscopic surgery (using a small joint imaging camera) and internal fixation were compared with ORIF. It reported better functional outcome and knee mobility in the arthroscopy group. There were no repeated operations.

    Three studies compared various bone substitutes with bone grafts for the treatment of bone defects, but these studies reported only a few outcomes.In 1 study, 2 groups showed similar results for the number of participants with good walking, climbing stairs, squatting, and jumping abilities when evaluated 1 year after treatment. In all 3 studies, both groups had a similar incidence of specific complications. One study found that all participants in the bone graft group suffered from more prolonged pain at the site of the bone graft. Two studies reported similar results in terms of range of motion in the two groups, while the third showed better results in the bone substitute group when evaluated 1 year after treatment.

    Conclusions

    There is insufficient evidence to unequivocally determine the best surgical fixation and treatment for bone defects in tibial plateau fractures in adults. Well-conducted clinical trials are still needed to make informed decisions in the clinic.

    part 1 – ankle fractures – Our news

    Modern methods of fracture treatment as a factor in the early activation of patients: part 1 – ankle fractures

    Ankle fractures are intra-articular fractures of the ankle joint.Their frequency reaches 20% of all fractures, which in absolute terms is 100-180 cases per 100,000 adults per year. Most often, ankle fractures result from “indirect injury” as a result of the twisting of the lower limb. (Fig. 1)

    Given the intra-articular nature of the fracture, the goal of treatment is to fully restore the relationship and stability of the joint. The stability of the ankle joint depends not only on the bone structures that form it, but also on the ligamentous structures.It is not always possible to achieve this goal when using conservative techniques, especially in complex fractures of the ankles. Conservative treatment is also associated with such problems as prolonged immobilization in a plaster cast (up to 3 months), muscle atrophy, contracture (stiffness) in the joint, improper fusion and the development of post-traumatic arthrosis.

    In the course of surgical treatment, it is necessary to fix not only bone structures, but also to create favorable conditions for the restoration of the ligamentous apparatus in the correct position.The use of modern metal implants and advanced surgical techniques makes it possible not only to achieve the solution of these problems, but also to achieve the earliest possible activation of patients, the possibility of walking with an early load on the limb.

    Clinical example.

    Attending physician: candidate of medical sciences Stoyukhin Sergey Sergeevich.

    A 65-year-old patient, on July 31, 2017 at the dacha, fell down the stairs, twisted her right lower limb in the ankle joint.Upon returning to Moscow, she turned to the emergency room, where X-rays were taken, a fracture of both ankles of the right shin with displacement of fragments was revealed, as well as a fracture of the posterior edge of the tibia. Damage to the 3 structures responsible for the stability of the ankle joint is indicative of the highly unstable nature of the fracture (Fig. 2) .

    The small size of the fragment of the fracture of the posterior edge of the tibia indicates the detachment of the most durable posterior portion of the syndesmotic complex together with the bone fragment.This syndesmotic complex maintains the ankle fork in the correct position. The patient was sent from the trauma center to our clinic, where, in the admission department, a plaster cast was applied to her in order to provide temporary fixation of the fracture. After further examination, the operation was performed – osteosynthesis of the fibula with a plate and screws, the inner ankle with a lag screw, stabilization of the syndesmosis with a positional screw. The placement of the positioning screw allows the fusion of the syndesmosis to be achieved in the correct position (Fig.3) .

    In the postoperative period, plaster immobilization is not used, which makes it possible to start developing movements in the ankle joint from 1 day after the operation. The duration of fixation of syndesmosis is 6-8 weeks. During this interval, the patient moves with the help of additional support with a minimum load on the operated limb (load by the weight of the limb). After removal of the positioning screw, a progressive axial load (Fig. 4) is allowed.Thus, early restoration of the support ability of the lower limb using modern methods of osteosynthesis and high-tech metal fixators allows achieving better functional results and reducing the period of general disability in patients with intra-articular fractures of the ankles.

    90,000 Fractures of the bones of the foot – causes, symptoms, diagnosis and treatment

    Fractures of the foot bones according to various sources account for 2.5-10% of all fractures.Fractures of the foot bones occur both as a result of direct injury and as a result of indirect injury (unsuccessful jump, twisting of the foot, falling). The significance of foot fractures is determined by the high mutual dependence of all elements of this part of the body. Any change in the shape of one of the bones of the foot during a fracture leads to a change in the shape and function of the entire foot. Thus, fractures of the bones of the foot often cause the subsequent violation of normal support on the foot, the development of flat feet and secondary arthrosis.For diagnostic purposes, foot radiographs are performed in 2-3 projections. For fractures of the foot bones, open / closed reduction is performed, followed by immobilization for up to 1.5 months.

    General information

    Fractures of the bones of the foot according to various sources account for 2.5-10% of all fractures. The significance of foot fractures is determined by the high mutual dependence of all elements of this part of the body. Any change in the shape of one of the bones of the foot during a fracture leads to a change in the shape and function of the entire foot.Thus, fractures of the bones of the foot often cause the subsequent violation of normal support on the foot, the development of flat feet and secondary arthrosis.

    Anatomy of the foot

    The foot consists of 26 bones connected by small joints and a large number of ligaments. There are three sections of the foot: the tarsus, the metatarsus and the phalanges of the toes. The tarsus is formed by the calcaneus, talus, cuboid, scaphoid and three sphenoid bones.

    Proximally (closer to the center of the body), the talus is connected to the shin bones.Distally (further from the center of the body), the bones of the tarsus articulate with the bones of the metatarsus, which, in turn, form joints with the bones of the main phalanges of the fingers.

    Fractures of the tarsus

    Fractures of the talus

    The talus has features that distinguish it from the rest of the bones of the foot. First, the pressure of the entire weight of the human body is transmitted through the talus to the foot. Second, the talus is the only bone in the foot to which no muscle is attached.Thirdly, the talus plays a significant role in the formation of the arches of the foot.

    Fractures of the talus are rare in traumatology (about 3% of the total number of fractures of the bones of the foot), belong to the group of severe injuries to the bones of the foot and are often combined with other injuries (fractures of the ankles, dislocations of the foot, fractures of other bones of the foot). There are fractures of the body, head, neck, lateral or posterior edge of the talus.

    Fractures of the talus are more often the result of indirect trauma (twisting of the foot, jumping, falling from a height).Less commonly, injury is caused by compression of the foot or direct impact with a heavy object.

    Symptoms

    The patient complains of sharp pain in the damaged area. The foot and ankle joint are swollen, hemorrhages are visible on the skin, mainly in the area of ​​the inner ankle. When the fragments are displaced, deformation is revealed. Movement in the ankle joint is almost impossible due to pain.

    A sharp pain is determined when palpating at the level of the joint space, and with fractures of the neck, the pain is more pronounced in the front, and with fractures of the posterior process – along the posterior surface outward from the Achilles tendon.

    To confirm the fracture of the talus, determine its localization, identify the nature and degree of displacement of the fragments, X-ray is performed in 2 projections.

    Treatment

    In case of a displaced fracture, urgent reduction of the fragments is indicated. It should be borne in mind that with an increase in the duration of the injury, the comparison of bone fragments becomes sharply difficult or even impossible. Failure of closed reduction is an indication for open reduction or imposition of skeletal traction.

    For fractures of the posterior process, the plaster cast is applied for 2-3 weeks, for other fractures of the talus – for 4-5 weeks. From 3-4 weeks, the patient is recommended to remove the injured leg from the splint and make active movements in the ankle joint.

    Subsequently, exercise therapy, massage and physiotherapy are prescribed. Disability recovery occurs in 2.5-3 months. Within a year after injury, patients are recommended to wear instep supports to prevent traumatic flat feet.

    Scaphoid fractures

    This type of fracture of the bones of the foot, as a rule, occurs as a result of direct trauma (falling of a heavy object on the back of the foot). Less often, the cause of a fracture of the scaphoid is its compression between the sphenoid bones and the head of the talus. Often, fractures of the scaphoid bone are combined with other fractures of the bones of the foot.

    Symptoms

    Restricted leg support due to pain. Revealed swelling and hemorrhage on the back of the foot.Feeling of the scaphoid bone, turning the foot inward and outward, as well as abduction and adduction of the foot, cause severe pain in the area of ​​the fracture. To confirm a fracture of the scaphoid, an X-ray of the foot is performed in 2 projections.

    Treatment

    In case of scaphoid fractures without displacement of bone fragments, a circular plaster cast with carefully modeled arches of the foot is applied by a traumatologist. For fractures with displacement, reduction is performed. If the fragments cannot be repaired or retained, open reduction is performed.Fixation with a plaster cast is carried out within 4-5 weeks.

    Fractures of the cuboid and sphenoid bones

    The cause of injury is usually a fall of a heavy object on the back of the foot. The soft tissues in the damaged area are swollen. Pain is detected when probing, pressure, turning the foot inward and outward. Radiography is of great importance to confirm this type of fractures of the foot bones. Treatment – circular plaster cast for a period of 4-5 weeks. Within a year after such a fracture of the foot bones, the patient must wear an instep support.

    Metatarsal fractures

    Metatarsal fractures in frequency rank first among all fractures of the bones of the foot. Usually occur with the direct impact of a traumatic force (compression of the foot, a fall in gravity, or moving the foot with a wheel). Can be multiple or single. Depending on the level of damage, fractures of the head, neck and body of the metatarsal bones are distinguished.

    Single metatarsal fractures are very rarely accompanied by significant displacement of fragments, since the remaining intact metatarsal bones function as a natural splint, keeping the fragments from displacement.

    Symptoms

    Single fractures of the metatarsal bones reveal local edema on the dorsum and sole, pain when supporting and palpating. Multiple fractures of the metatarsal bones are accompanied by severe swelling of the entire foot, hemorrhages, pain on palpation. Support is difficult or impossible due to pain. Deformation of the foot is possible. The diagnosis is confirmed by X-ray data in 2 projections, and in case of fractures of the base of the bones of the metatarsus – in 3 projections.

    Treatment

    In case of metatarsal fractures without displacement, a posterior plaster splint is applied for 3-4 weeks.For fractures with displacement, closed reduction is performed, open osteosynthesis is performed, or skeletal traction is applied. The fixation period for such fractures of the foot bones is extended to 6 weeks. Then a special plaster cast “with a heel” is applied to the patient, and subsequently it is recommended to use orthopedic inlays.

    Fractures of the phalanges of the toes

    This type of fracture of the bones of the foot, as a rule, occurs with the direct impact of traumatic force (fall of weight, blow to the fingers).Fractures of the middle and nail phalanges of the fingers subsequently do not impair the function of the foot. Incorrect fusion of fractures of the main phalanges can lead to the development of post-traumatic arthrosis of the metatarsophalangeal joints, limited mobility and pain when walking.

    Symptoms

    The injured finger is cyanotic, swollen, sharply painful during movement, palpation and axial load. Fractures of the nail phalanx are often accompanied by the formation of a subungual hematoma. To confirm fractures of the phalanges, radiographs are performed in 2 projections.

    Treatment

    For fractures of the phalanges of the toes without displacement, a posterior plaster splint is applied. When the fragments are displaced, a closed reduction is performed.