Friday, February 11, 2011

Stress Fractures Are Very Limiting

Stress Fractures

A stress fracture is a tiny or incomplete crack in a bone that is often caused by overuse. Stress fractures occur most frequently inthe foot and ankle. Our onsite podiatrist Dr. Kerch is well trained to diagnose and treat this problem.

Stress fractures may be caused by a number of factors. Overuse or strain in the foot (fatigue fracture) is one of the most common causes, while weak bones (insufficiency fracture), caused by medical conditions such as osteoporosis, can also be a factor. Medications such as steroids can lead to stress fractures, as can a sudden increase in activity levels. All of these causes can and should be evaluated by an appointment when you have the signs and symptoms of a stress fracture.

Those signs may include pain that increases with activity and decreases with rest, pain that increases over time, or pain that persists even at rest. Often a stress fracture will result in swelling and a spot that feels tender to the touch.

If you experience any pain during physical activity or any of the symptoms described, you should make an appointment with Dr. Kerch or your own podiatrist. Prompt diagnosis and treatment of a stress fracture can often prevent further injury. Dr. Kerch will ask you to describe your signs and symptoms and then physically evaluate your foot. While x-rays will most likely be used for diagnosis, often stress fractures do not appear on regular x-rays for several weeks after the symptoms begin. In some cases, the fracture may never appear on an x-ray. In those cases, other diagnostic testing such as MRIs, ultrasounds, or bone scans may be recommended.
Many stress fractures can be treated with rest, ice and over-thecounter pain relievers. For most people, an appropriate period of rest will be sufficient for the bone to heal. In other cases, Dr. Kerch will develop a treatment program customized to your needs

Dr. Kerch has noticed an increase of patients presenting with stress fractures recently. "Be on the alert for signs and symptoms of a stress fracture. A thorough exam with X-ray and bone scan may be indicated if a stress fracture is suspected."
She says, " Take preventative actions to lower the severity of your stress fracture, to speed up healing or to prevent recurrence. Bracing or custom orthotics and proper shoe gear may be recommended as symptoms necessitate ."
At Your 2 Feet "therapy package" recommendations are available for purchase. You may need to immobilize the affected bone with a pneumstic boot, fracture shoe, or choosing from various foot and ankle splints. Dr.Kerch may be able to bill your insurance company for many items. They may be covered depending on your benefits.

More info:
The repetitive loading which produces these fractures is similar to repetitive bending of a paper clip which eventually breaks. Once broken, it can have a major impact on your workout program and life in general.The loading can be due to many factors, but Dr.Kerch tells her patients, "The factors over which we have some control are distance, shoe wear, surfaces and flexibility. Don't increase the distance or activity more than 10% per week. Shoe wear which is specific to an activity, such as a running shoe for running, are more than marketing hype. They provide both support as well as partially compensate for the hardness of your workout surface. Using a treadmill reduces impact forces compared with running on asphalt, and a dirt trail is likely to be less problematic than an asphalt surface. Similar to the 10% rule for distance, you need to gradually transition from indoor treadmill to outdoor surface activities as the weather improves. Warming up and maintaining flexibility, and especially stretching of the Achilles tendon, will reduce forefoot impact and help to preserve normal foot shock-absorbing mechanics.
Again,the typical symptom of a stress fracture is pain, which may occur suddenly or may gradually increase over several days. Swelling in the foot and lower leg is also common. Treatment for a stress fracture of the foot includes activity modification and use of a stiff-soled shoe for approximately 2-4 weeks after injury. Depending on the location of the fracture, immobilization in a cast boot or use of crutches may be needed. Fractures in the 5th metatarsal, talus and navicular bone heal very slowly or may not heal at all due to poor blood supply. Longer periods of treatment or surgical intervention may be necessary in order to heal these types of fractures.
The best way to avoid a stress fracture of the foot when starting an exercise program is to take it slow, know your limits and follow a sensible program.
Red flags to watch for after any workout include:
.Pain in the foot or lower leg that persists more than 72 hours
•Swelling of the foot or leg that persists for more than 24 hours
•Pain which increases with exercise or walking
•Pain at rest or with elevation of the legs

Preventative measures include:
•Select the proper footwear for the specific type of exercise
•Start out slowly when beginning an exercise program following a layoff period
•Walk and stretch to warm up gradually before running or walking
•Focus on stretching and strengthening the muscles in the calf
•Increase running or walking distance and speed gradually, in increments no greater than 10% per week
•Avoid unaccustomed strenuous sprinting
•Take the time to cool down properly after exercise
These simple measures may prevent stress fractures of the foot and ankle and allow you to achieve success.
Visit Your 2 Feet or make an appointment with Dr. Kerch at 206-786-0064. We are located at 1201 Pine the base of Capital Hill in Seattle.

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