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Stress Fractures of
the Foot, Ankle and Leg
by Amol Saxena, DPM, FACFAS
Palo Alto Medical Foundation
Department of Sports Medicine
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Amol Saxena, DPM is a podiatrist at the Palo Alto Medical
Foundation, Department of Sports Medicine at Palo Alto, California.
The July/August issue of the Journal of the American Podiatric Medical
Association was devoted to “Special Topics on Sports Medicine and Ankle
Pathology”. Dr. Saxena wrote the introduction and had 5 articles published in
that issue.
His lecture on stress fractures of the Foot, Ankle, and Leg will be of
particular interest to physicians treating high performance athletes or even
weekend warriors.
Stress fractures are pathologic insufficiencies of bone. They are more commonly
seen in athletes. The pain associated with stress fractures increases with
activity. Diagnostic testing includes Bone Scans, CT, and MRI. Dr. Saxena feels
that the CT Scan is the best method to evaluate fracture patterns and prognosis.
Often fractures of this type are slow to respond. For these slow responding
fractures, Dr. Saxena recommends the use of pulse electrical magnetic fields. He
describes a patient of his who was training for the Olympic Trials and developed
a metatarsal stress fracture. With the help of a bone stimulator, X rays
demonstrated complete healing and bone callus formation in 16 days.
Certainly not all stress fractures heal this early. Proximal 4th and 5th
metatarsal stress fractures are notoriously slow. Dr. Saxena uses various
studies to illustrate why athletes with proximal 5th metatarsal stress fractures
have better and more rapid outcomes with surgery. 50% of those treated
conservatively end up having surgery at any rate. Dr. Saxena describes some of
his own research with navicular fractures. He also has developed a
classification system for these injuries.
How do you distinguish between cuboid syndrome and a proximal 4th metatarsal
stress fracture? Is it resilient plantar Fasciitis or a calcaneal stress
fracture? Does that patient with multiple stress fractures have an underlying
metabolic pathology? Do NSAID’s help or hinder treatment of stress fractures?
Could you identify a stress fracture of the lower leg?
Take a seat; spend some time with Dr. Saxena and get the answers.
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