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Fracture, Eh? Part Two

This is Ironman Week here in Kona as the sleepy fishing village and
occasional port for cruise ships turns into Triathlon Central. There are
people everywhere, fit people, running and biking up and down Alii Drive.
I hadn’t been here an hour before seeing Norman Stadler and Chrissie
Wellington. Good luck to them both on Saturday! It’s going to be a
fun week.

“Dig Me” Beach, a term I heard
credited to Scott Tinley, is seen here, soon to be clogged with
swimmers trying to get used to the change from simply following the
line on the bottom of the pool to the gentle waves and salt water of
the Pacific in Kailua Bay.

But the athlete with an injury like a stress fracture is
sitting home, an opportunity missed. I covered the basics of stress fractures
here 1/15. That these are in the category of overuse injuries where the
muscular envelope of the lower extremity becomes fatigued and the skeleton
is unable to adapt to the increased load.

The bone fractures as it is unprepared for the intensity of exercise delivered.
This might be advancing one’s training program
too quickly, changing from the relative forgiveness of the running track to
asphalt or concrete, aged or improper equipment or increasing exercise duration
as a tennis player with a substantial increase in court time.

There are 26 bones in the foot and most likely all of them have been subject
to a stress fracture at one time or another. They are frequently seen in the
other bones of the lower extremity when insufficient rest is included between
workouts. People taking Prednisone, Dilantin and other medications are at
increased risk. Women have more than men.

The predisposing symptom is pain, not so much at
rest, but brought on by exercise and it worsens. Although occasionally
visible as a crack in the bone on x-ray, frequently these films will be
negative. If the examiner finds point tenderness over a bone and a stress
fracture is suspected, an advanced study like an MRI, or more likely a bone
scan, will be order. (This is not to be confused with the DXA, the bone scan
used to measure osteoporosis, predominantly in women.)

If diagnosed, the order of the day will be rest.
This can be up to 6-8 weeks, some will be placed on crutches or given a fracture
boot, but if one returns to sport before it heals, chronic difficulties can
follow making healing a challenge. Triathletes might be shifted to pool running
and biking so as not to lose excessive fitness.

So, if you have recurring pain in the same location, and think this may
potentially describe you, get it checked out, you’ll be glad you did.

John Post, MD Kona Resident 10/1-9