Sunday, October 5, 2014

Stress Fractures: Week 5 Fantasy Football Ankle And Foot Injury Report

Stress Fractures
 A big deal in the NFL. 

 Simple problem if you have the TIME to heal.
         We are 5  weeks into the NFL season and stress fractures are ruining NFL players and fantasy football players seasons.  In the last 4 weeks the following players have had issues related to new or  old stress fractures: Michael Crabtree, Austin Seferian-Jenkins, Julio Jones, Manti Te'o,  and Marvin Jones.  So what are these "stress fractures" and what is the big deal?

I see stress fractures in the office almost weekly. They are very common and more importantly easy to treat!  The difficulty is in getting better.  Healing is 90% up to what the patient does and 10% what the patient is.  What the patient does (taking it easy) after the injury is often more important than who the patient is (healthy).  Before we get too far ahead of ourselves we should probably describe a stress fracture.

Two broken bones.
The one on the right is a "healing" stress fracture
The one on the left is "newer"

The best example of a stress fracture is to grab a branch from a  LIVE shrub or tree and bend it.  You will hear a snap, but the branch will stay together.  This is what happens to bones in the foot.  If too much stress is placed on the bone it will snap, but not fall apart.  That is why stress fractures are often not seen on X-rays.  The foot will start to hurt all the same.  If you keep bending the branch back and forth, eventually it will snap in two.  Likewise, if you keep "stressing" the foot (running, jumping, walking) the foot bone may also snap in two.

The treatment is SIMPLE.  Stop stressing your foot!  I typically give the patient a fracture boot and say, "If you wear this all the time, except for sleeping and bathing, you should be healed in 1-2 months.  BUT YOU HAVE TO TAKE IT EASY!  If you get the boot and pretend your foot is not broken and run around all day long it may take 2-6 months.  If you only wear the boot "sometimes" it may never heal or get worse.

The issue with football players is that they, "have to go to work"  aka play football.  This is why it is so difficult for them.  Often times surgery is done to help get them back playing faster.  Screws are often used to help protect the area until the bone heals.  This is rarely needed for patients in my office as they are not often professional athletes that need to play ASAP.  

A surgery may also need to be done if the bone does not heal and the patient develops a non-union.  Most of the time this is caused when the patient does not "take it easy" or wear the boot.  Operating on this type of person has additional challenges.  If the person did not listen to the doctor before surgery what makes you think that the will "take it easy" after surgery.  Extensive counseling, bone simulators and some good luck are often needed to heal the injury.

Most of the time stress fractures are caused by an increase in physical activity.  Either too much of a "old activity" or starting a "new activity."  Athletes will get these injuries from increasing the "old activity".  They are playing too much, too hard and over stressing their body.  More often, I see the starting a "new activity" causing stress fractures.  This is the person who is starting to get in shape or starts a a new exercise activity.  An example would be starting running 5 miles a day.  It is safer to start a half mile a day and increasing a half mile a week until you reach your goal of 5 miles. This often occurs to individuals who "take a month off". When start exercising again they need to slowly progress to their normal activities.
There has been a few studies that show orthotics "may" help prevent stress fractures.  I do not recommend orthotics to prevent initial stress fractures as most often corrected training is all that is needed.  I do use orthotics in "special cases".  These are certain patients with repeat injuries.  This may be caused by diabetes, osteoporosis, and even in long distance runners.  


  1. I used to play football in colledge too, but I f-worded my knee, so all I can do now is sit back and watch the news. Btw here's a site you all could use . Its got news, podcasts and all that type of stuff for the harcore football fan.

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