Stress FractureMedical Author:
Benjamin Wedro, MD, FACEP, FAAEM
Benjamin Wedro, MD, FACEP, FAAEMDr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center. Medical Editor:
Melissa Conrad Stöppler, MD, Chief Medical Editor
Melissa Conrad Stöppler, MD, Chief Medical EditorMelissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Stress Fractures: Some Take Longer to Heal Than OthersMedical Author: Benjamin C. Wedro, MD, FAAEM
It takes a lot of effort to support 7 feet 6 inches and the two tons of force generated when NBA basketball star Yao Ming walks or jumps. The cushioning that absorbs the shock of his weight rests on two feet and their joints, ligaments, and muscles. The force of that weight during running can multiply a person's weight by more than12 times. Unfortunately for the Houston Rocket basketball player, his bones couldn't withstand the constant pounding and he developed a stress fracture of the navicular bone of his foot. The navicular bone helps support the arch of the foot and is a bridge between the bones of the ankle and those of the toes. The bony arch is also supported by the plantar fascia, the thick band of tissue that connects the heel to the front of the foot. The solid bones and the pliable ligaments flex the foot to disperse the forces generated with walking, running, and jumping. But if the force placed on the bone is greater than its ability to withstand it, small micro fractures can occur in the bones that can develop into a stress fracture. Stress Fracture OverviewStress fractures can be considered an overuse injury of a bone. The bones in the body are constantly changing, responding to the work load that is placed upon them, and there is a constant turnover of cells as bone acts to repair itself. The more load placed on the bone, the more likely that calcium will be placed at that site. The less use a bone receives, the less calcium can be found within it. If the stress of repetitive loads overwhelm the ability of the bone to repair itself, small cracks can begin to occur within the bone structure. This is especially evident in the bones of the foot, leg, and pelvis. These bones need to absorb the forces created from walking, running, and jumping. Up to 12 times the weight of the body may be generated with each step; and the bones, joints, muscles, and ligaments need to cushion the body against that force. Bone is normally in homeostasis (homeo= same + stasis=standing still), meaning that the natural turnover of bone cells is in balance between osteoclast activity (bone breakdown) and osteoblast activity (bone creation). When bone is under stress, it undergoes microscopic damage. Osteoclast cells are stimulated to absorb bone, and the injured site is weakened. If a long period of time elapses prior to the next injury, osteoblast cells produce more bone cells to protect the damaged area. If there is not enough time for the osteoblasts to produce more bone cells in the injured area; the micro fractures can join together to form a large enough area to cause a stress fracture. Symptoms of a stress fracture may include pain and swelling, particularly with weight bearing on the injured bone. Often plain X-rays may appear normal. If stress on the area of the compromised bone continues, and the microscopic damage increases in the area; the bone's integrity can be completely disrupted and cause a fracture that can be recognized on X-rays. Stress fractures generally often occur in the following locations:
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Stress Fracture
Arch Pain Overview
Each foot contains 24 bones, which form two arches. The longitudinal arch runs the length of the foot, and the transverse arch runs the width. The bones of the arch are primarily held together by the shape with which they fit with each other and by fibrous tissues known as ligaments that serve to hold the bones to each other. The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot. There are also fat pads in the foot to help with weight-bearing and absorbing impact. Arch pain can occur whenever something goes wrong with the function or interaction of any of these structures.
Arch Pain Causes
The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. When something happens to these structures, pain...
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