The American Orthopaedic Foot & Ankle Society offers injury prevention advice
The American Orthopaedic Foot & Ankle Society (AOFAS) has a message for previously sedentary Americans who will head to the gym this New Year: take it slow. Stress fractures are the most common overuse injuries of the foot and ankle. They occur with a rapid increase in physical activity (too much too quickly). Stress fractures result from a series of loading and unloading cycles that cause damage to the bone. If these forces continue and the bone is not able to repair itself fast enough, a fracture may occur.
F. Ray Nickel, MD, an active AOFAS member who practices in Ventura, California and treats many patients with sports related foot and ankle injuries offers the following advice, "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. Nickel tells his 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."
According to the AOFAS, 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 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 with your New Year's resolution. For more information on stress fractures as well as resources on foot and ankle care go to the AOFAS website www.aofas.org. The site also features a surgeon referral service that makes it easy for patients to find a local orthopaedic surgeon specializing in foot and ankle care.
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