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Sealey article-5-5-14by Randolph Sealey, MD
The Foot & Ankle Center at Danbury Orthopedics

It’s Spring at last, and with it comes a welcome return to outdoor activity. If you’re taking your fitness regimen outside, after months of exercising indoors, be aware that running or jogging on roads and trails means a major change to the impact exerted on feet and ankles. Even strong athletes experience a big change in lower extremity forces as they move from indoor facilities to outdoor terrain … forces that can lead to stress facture.

Stress fractures are a unique type of injury that occurs when the bones are overworked. The lower extremity, and specifically the foot and ankle region, accounts for the majority of stress fractures. In fact, 80% of these fractures occur in the tibia, fibula, metatarsal or calcaneus. 

Who’s at risk, and why
It’s no coincidence that a Prussian military surgeon was the first to describe stress fractures in an 1855 medical journal. Military personnel are at higher risk for these injuries, especially if there has been a change in their training. Runners also are more prone to stress fractures. Also at risk are people with certain foot types such as very high arches or a long second metatarsal fractures. And finally, hormonal imbalance such as hyperthyroidism, amenorrhea or osteoporosis can make the bones more vulnerable to stress, as can systemic problems such as smoking, alcohol abuse, nutrition problems and certain medications.

Diagnostic detective work
Because clinical signs of this injury can be so misleading, the physician’s experience is essential to swift diagnosis. While sometimes the patient experiences an actual “snap” of bone breakage, more often the presentation of symptoms is quite subtle. Patients can have vague discomfort, swelling, redness, tenderness – symptoms easily confused with infection. X-rays are usually taken, but visualizing the fracture may not be possible until bone begins to heal in about 4-6 weeks. Adding to the confusion, a “stress reaction” fracture (a type of stress fracture) will never appear on an X-ray! However, other imaging such as a bone scan or MRI can reveal the injury immediately. 

How to heal
Most stress fractures of the foot and ankle will heal non-operatively within 6–12 weeks by following the prescribed treatment regimen. During the healing period, the patient will need to wear a hard-sole shoe, boot or cast, and engage only in low-impact exercise such as swimming, stationary bike, resistance bands and low-weight strengthening. Excessive use of anti-inflammatories is not recommended as this impairs the body’s ability to heal bones. 

Once the patient is free of pain and X-rays show good healing, a gradual return to sports can begin.  Orthotics (shoe inserts) and an appropriate training regimen can help prevent recurrent stress fractures in runners and other athletes. 

Some stress fractures that occur in certain foot bones do require surgery, so these injuries should never be taken lightly. If you suspect a lower extremity stress fracture, don’t hesitate to make an appointment. The sooner you seek proper treatment, the sooner you can ‘Spring back’ into action.

Additional resources
Danbury Orthopedics is a proud sponsor of the Run Like A Mother event in Ridgefield, CT this Sunday, May 11th. As part of this sponsorship, Dr. Sealey will be on site at Ballard Park at the race finish, answering questions about the foot & ankle, injury prevention and treatment.

About Dr. Sealey
Dr. Randolph Sealey is the only fellowship-trained orthopedic foot and ankle subspecialist in the greater Danbury area. He acquired his surgical expertise during his fellowship at the world-renowned Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, Maryland. In 2008, he received the prestigious Roger A. Mann Award, the highest clinical research honor given by the American Orthopaedic Foot and Ankle Society. He has become a major referral resource for foot and ankle trauma ranging from simple to complex. A Newtown resident, Dr. Sealey leads the The Foot & Ankle Center at Danbury Orthopedics.

About Danbury Orthopedics:
Danbury Orthopedics, now celebrating its 60th year, is a multi-specialty practice staffed by leading surgeons and specialists in orthopedic care; the practice is a member of Western Connecticut Orthopedic Specialists, along with New Milford Orthopedics and The Hand Center of Western Connecticut, providing comprehensive care to the community for over 90 years. The practice’s Centers of Excellence provide integrated treatment, offering individualized and compassionate care by a team of specialists. The goal of the practice is to help patients regain mobility, lead active lives and attain optimal wellbeing. To make an appointment with Dr. Sealey, or learn more about Danbury Orthopedics, please visit http://www.dortho.com/ or call 203.797.1500.

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