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Q re: stress fracture

Posted by elliott on 11/29/02 at 09:32 (101398)

I've always been suspicious that I had a stress fracture in my right foot years ago which started my foot problems (TTS and PT tendon). I didn't have an xray at the time, but I have since (years later) had an MRI, two bone scans, and an xray. Other than the first bone scan picking up a possible navicular stress fracture (which, based on its location, could indeed explain my pain) they did not show evidence of a stress or complete fracture, and as a result the doctors have discounted this .

Is it possible to have what might have turned out to be a debilitating stress fracture and little or nothing showing up? Is it possible that it would not heal over all this time (6 years--running on it probably exacerbated it, but I have not tried in the last 2)? Could it have resulted in severe arthritis (and would that be detected)? If it is indeed a nonhealing stress fracture, is there anything that could be done about it? (I already tried a few bouts of 3-week walking-boot casting to no effect.) I would doubt ESWT as there is no longer just one confined area of pain, but rather pain and weakness both medially and laterally (perhaps along the course of the navicular). Thanks.

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Re: Q re: stress fracture

Dr. David S. Wander on 11/29/02 at 14:05 (101422)

Elliot,

Stress fractures can often be missed on initial x-rays but usually become evident on follow up x-rays when healing begins. Additionally, a stress fracture will usually 'light up' on bone scans. Althoug MRI's are excellent for soft tissue pathology, CT scans are still the gold standard for bone injury. Fractures (definite fractures) that are not healing properly can be treated with electrical bone stimulation units. Discuss all your concerns with your treating doctor.

Re: Q re: stress fracture

elliott on 11/30/02 at 21:24 (101525)

Dr. Wander, thanks for your comments. Can electrical stim be used over a wide area without strong evidence of a fracture 'just in case' something's there? If so, who does it? Pod? PT? How many treatments? Thanks.

Re: Q re: stress fracture

Dr. David S. Wander on 12/01/02 at 11:17 (101546)

No, I've never heard of the use of a bone stimulation unit 'just in case' there's a fracture. There must be a definite diagnosis, because a bone stimulator does have some contra-indications. Secondly, insurance companies only pay for the devices if there is a non-healing fracture. These units are generally used by orthopedic surgeons and podiatrists. This is NOT the same as an electrical stimulator used for physical therapy.

Re: Q re: stress fracture

elliott on 12/01/02 at 13:48 (101559)

Thanks for your response again, Dr. Wander. The problem is, I have been to numerous really big-name orthos and pods and have had rather differing opinions on what appears to be instep instability and continuous lateral instep pain, which resulted after a TTS release and PT synovectomy and an attempt to resume running thereafter. Two docs diagnosed a raised first metatarsal, but their surgical remedies differ dramatically (one wants to do fusions and osteotomies, the other a single fusion and loads of tissue procedures), the confusion being that there is no obvious PT dysfunction, rather unusual, I understand. Both of those surgeries sound risky to say the least. And yet others disagree even about the diagnosis, let alone the surgical remedies, but they aren't sure what's going on. It's hard having to make decisions under these circumstances, so I keep hoping I'll get better, and keep hobbling in pain. The orthotics prescribed have helped but not entirely. If I need to wait longer, fine, but I wish someone would tell me that; there's no one doc really in charge as there are differing opinions as to what's going on. That's why I was thinking about just trying electrical stim, but you're saying that's probably not appropriate either.

Re: Q re: stress fracture

pala on 12/01/02 at 16:54 (101565)

i am going through a grueling rehab from hell. if i were to mri every pain in my feet and toes that accumulate and never seem to heal, i would live in an mri machine. so i'm taking calcium and hoping for the best. i don't know what else to do but carry on never quite knowing if i have fractured something. are there some guidelines to tell if it's stress fractured just by examination or sensations?

Re: Q re: stress fracture

Dr. David S. Wander on 11/29/02 at 14:05 (101422)

Elliot,

Stress fractures can often be missed on initial x-rays but usually become evident on follow up x-rays when healing begins. Additionally, a stress fracture will usually 'light up' on bone scans. Althoug MRI's are excellent for soft tissue pathology, CT scans are still the gold standard for bone injury. Fractures (definite fractures) that are not healing properly can be treated with electrical bone stimulation units. Discuss all your concerns with your treating doctor.

Re: Q re: stress fracture

elliott on 11/30/02 at 21:24 (101525)

Dr. Wander, thanks for your comments. Can electrical stim be used over a wide area without strong evidence of a fracture 'just in case' something's there? If so, who does it? Pod? PT? How many treatments? Thanks.

Re: Q re: stress fracture

Dr. David S. Wander on 12/01/02 at 11:17 (101546)

No, I've never heard of the use of a bone stimulation unit 'just in case' there's a fracture. There must be a definite diagnosis, because a bone stimulator does have some contra-indications. Secondly, insurance companies only pay for the devices if there is a non-healing fracture. These units are generally used by orthopedic surgeons and podiatrists. This is NOT the same as an electrical stimulator used for physical therapy.

Re: Q re: stress fracture

elliott on 12/01/02 at 13:48 (101559)

Thanks for your response again, Dr. Wander. The problem is, I have been to numerous really big-name orthos and pods and have had rather differing opinions on what appears to be instep instability and continuous lateral instep pain, which resulted after a TTS release and PT synovectomy and an attempt to resume running thereafter. Two docs diagnosed a raised first metatarsal, but their surgical remedies differ dramatically (one wants to do fusions and osteotomies, the other a single fusion and loads of tissue procedures), the confusion being that there is no obvious PT dysfunction, rather unusual, I understand. Both of those surgeries sound risky to say the least. And yet others disagree even about the diagnosis, let alone the surgical remedies, but they aren't sure what's going on. It's hard having to make decisions under these circumstances, so I keep hoping I'll get better, and keep hobbling in pain. The orthotics prescribed have helped but not entirely. If I need to wait longer, fine, but I wish someone would tell me that; there's no one doc really in charge as there are differing opinions as to what's going on. That's why I was thinking about just trying electrical stim, but you're saying that's probably not appropriate either.

Re: Q re: stress fracture

pala on 12/01/02 at 16:54 (101565)

i am going through a grueling rehab from hell. if i were to mri every pain in my feet and toes that accumulate and never seem to heal, i would live in an mri machine. so i'm taking calcium and hoping for the best. i don't know what else to do but carry on never quite knowing if i have fractured something. are there some guidelines to tell if it's stress fractured just by examination or sensations?