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Hatch R, Devito P, Reams M, Pena F. Foot and Ankle Bone Marrow Edema Assessment in Long Distance Runners. Foot Ankle Int 2023; 44:1231-1238. [PMID: 37994648 DOI: 10.1177/10711007231201332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND The clinical significance of foot and ankle bone marrow edema (BME) is poorly understood. METHODS Magnetic resonance imaging (MRI) and the visual analog scale (VAS) pain scores were collected for 17 runners who participated in the Twin Cities Marathon, immediately postmarathon and at a 6-week follow-up. Bone marrow edema lesions were classified using lesion frequency, anatomical location, and grading scale change to calculate a BME score for each affected bone. Spearman rank correlation coefficient test was used to identify a possible correlation between VAS and postmarathon BME. A paired Student t test was used to detect differences between total mileage ran 6 weeks postmarathon in participants with or without BME. RESULTS After completing the marathon, 8 BME lesions were identified in 5 participants (29.4%; 5/17), 3 were men, and 2 were women, with a mean age of 33.8 years (range: 24-52), and BMI of 22.9 ± 4. All lesions were resolved on 6-week follow-up imaging. VAS pain scores did not correlate with postmarathon BME. A significant difference in total miles logged over 6 weeks postmarathon could not be found among participants with and without BME. CONCLUSION Foot and ankle BME changes identified by MRI were not correlated to clinical symptoms and may resolve with self-directed activity in less time than other areas of the lower extremity. LEVEL OF EVIDENCE Level II, Prospective Cohort Study.
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Affiliation(s)
- Ryan Hatch
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul Devito
- TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Megan Reams
- TRIA Orthopaedic Center, Bloomington, MN, USA
| | - Fernando Pena
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Zandbergen MA, Ter Wengel XJ, van Middelaar RP, Buurke JH, Veltink PH, Reenalda J. Peak tibial acceleration should not be used as indicator of tibial bone loading during running. Sports Biomech 2023:1-18. [PMID: 36645012 DOI: 10.1080/14763141.2022.2164345] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/27/2022] [Indexed: 01/17/2023]
Abstract
Peak tibial acceleration (PTA) is a widely used indicator of tibial bone loading. Indirect bone loading measures are of interest to reduce the risk of stress fractures during running. However, tibial compressive forces are caused by both internal muscle forces and external ground reaction forces. PTA might reflect forces from outside the body, but likely not the compressive force from muscles on the tibial bone. Hence, the strength of the relationship between PTA and maximum tibial compression forces in rearfoot-striking runners was investigated. Twelve runners ran on an instrumented treadmill while tibial acceleration was captured with accelerometers. Force plate and inertial measurement unit data were spatially aligned with a novel method based on the centre of pressure crossing a virtual toe marker. The correlation coefficient between maximum tibial compression forces and PTA was 0.04 ± 0.14 with a range of -0.15 to +0.28. This study showed a very weak and non-significant correlation between PTA and maximum tibial compression forces while running on a level treadmill at a single speed. Hence, PTA as an indicator for tibial bone loading should be reconsidered, as PTA does not provide a complete picture of both internal and external compressive forces on the tibial bone. .
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Affiliation(s)
- Marit A Zandbergen
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- Department of Rehabilitation Technology, Roessingh Research and Development, Enschede, The Netherlands
| | - Xanthe J Ter Wengel
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Robbert P van Middelaar
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- Department of Rehabilitation Technology, Roessingh Research and Development, Enschede, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
| | - Jasper Reenalda
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
- Department of Rehabilitation Technology, Roessingh Research and Development, Enschede, The Netherlands
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083360 PMCID: PMC6357658 DOI: 10.23750/abm.v88i4-s.6800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head. (www.actabiomedica.it)
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083360 DOI: 10.23750/abm.v88i4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head.
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5
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Biz C, Berizzi A, Crimì A, Marcato C, Trovarelli G, Ruggieri P. Management and treatment of femoral neck stress fractures in recreational runners: a report of four cases and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:96-106. [PMID: 29083360 PMCID: PMC6357658 DOI: 10.23750/abm.v88i4 -s.6800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 12/28/2022]
Abstract
Femoral neck stress fractures (FNSFs) in healthy young subjects are uncommon and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders followed by amenorrhea and osteoporosis. This case report describes four young and middle-aged, active female recreational runners who developed stress fractures of the femoral neck. In three of them, with a clinical history of persistent pain in the groin region, which worsened during training, early diagnosis by MRI was considered essential in detecting the fractures. The patients were clinically, metabolically and radiographically evaluated; they were then treated and followed-up at our institution. Only one case was treated conservatively, while the others underwent surgical internal fixation using a screw-plate (DHS®). All of them returned to sport physical activity after a recovery period. Regarding the challenging management of FNSFs, our report highlights the importance of groin pain, especially in athletic females, an early diagnosis by MRI, and a proper classification of these injuries for a correct choice of treatment in order to prevent further dislocation and avoid avascular necrosis of the femoral head.
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6
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Bilateral stress fracture of femoral neck in non-athlete - case report. Rev Bras Ortop 2017; 51:735-738. [PMID: 28050549 PMCID: PMC5198079 DOI: 10.1016/j.rboe.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 02/08/2023] Open
Abstract
Bilateral stress fracture of femoral neck in healthy young patients is an extremely rare entity, whose diagnostic and treatment represent a major challenge. Patients with history of hip pain, even non-athletes or military recruits, should be analyzed to achieve an early diagnosis and prevent possible complications from the surgical treatment. This report describes a 43-year-old male patient, non-athlete, without previous diseases, who developed bilateral stress fracture of femoral neck without displacement. He had a late diagnosis; bilateral osteosynthesis was made using cannulated screws. Although the diagnosis was delayed in this case, the study highlights the importance of the diagnosis of stress fracture, regardless of the activity level of the patients, for the success of the treatment.
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Oliveira USD, Labronici PJ, Neto AJ, Nishimi AY, Santos Pires RE, Penteado Silva LH. Fratura de estresse bilateral do colo do fêmur em não atleta – relato de caso. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Polacek M, Småbrekke A. Displaced stress fracture of the femoral neck in young active adults. BMJ Case Rep 2010; 2010:bcr0220102749. [PMID: 22778106 PMCID: PMC3029614 DOI: 10.1136/bcr.02.2010.2749] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Stress fractures of the femoral neck in healthy individuals are rare and most prevalent among long-distance runners and military recruits. Women seem to be at higher risk of developing stress fractures because of possible eating disorders and, thereby, following amenorrhoea and osteoporosis. The majority of fractures of the femoral neck are undisplaced. However, they might progress into displaced fractures with avascular necrosis of the femoral head and following development of osteoarthritis as a probable consequence even when treated properly. Early diagnosis with MRI or radionuclide scanning in patients with a history of pain in the groin region during training might be crucial in detecting the fractures at early stages; thereby preventing possible complications following surgical treatment of displaced fractures. The authors present a report of two young adults who developed displaced fractures of the femoral neck and were treated with closed reduction and internal fixation.
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Affiliation(s)
- Martin Polacek
- Orthopaedic Department, University Hospital in North Norway, Tromsø, Norway.
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Okamoto S, Arai Y, Hara K, Tsuzihara T, Kubo T. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report. BMC Sports Sci Med Rehabil 2010; 2:6. [PMID: 20205723 PMCID: PMC2844364 DOI: 10.1186/1758-2555-2-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/05/2010] [Indexed: 11/17/2022]
Abstract
This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad.
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Affiliation(s)
- Shinichi Okamoto
- Dept of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Arai
- Dept of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kunio Hara
- Dept of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Tsuzihara
- Dept of Orthopaedic, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Murasakino Unrinin-tyo17, Kita-ku, Kyoto, 603-8214, Japan
| | - Toshikazu Kubo
- Dept of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Trappeniers L, De Maeseneer M, De Ridder F, Machiels F, Shahabpour M, Tebache C, Verhellen R, Osteaux M. Can bone marrow edema be seen on STIR images of the ankle and foot after 1 week of running? Eur J Radiol 2003; 47:25-8. [PMID: 12810218 DOI: 10.1016/s0720-048x(02)00221-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate whether initiation of running in sedentary individuals would lead to bone marrow edema on MR images, within the time span of 1 week. MATERIALS AND METHODS The feet of 10 healthy volunteers were imaged by MR imaging before and after running during 30 min a day for 1 week. The images were evaluated by consensus of 2 musculoskeletal radiologists who graded the presence of bone marrow edema on a 4-point scale. Edema scores and number of bones involved before and after running were compared statistically. RESULTS Edema was present on the baseline images in 3 subjects. After running edema showed an increase or was present in 5 subjects. The changes after running were statistically significant. Bones involved were the talus, calcaneus, navicular bone, cuboid bone, and 5th metatarsal. CONCLUSION Edema patterns can be seen in the feet of asymptomatic individuals. During initiation of running an increase of edema or development of new edema areas can be seen.
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Affiliation(s)
- L Trappeniers
- Department of Radiology, Vrije Universiteit Brussel, Brussels, Belgium
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Lassus J, Tulikoura I, Konttinen YT, Salo J, Santavirta S. Bone stress injuries of the lower extremity: a review. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:359-68. [PMID: 12143987 DOI: 10.1080/000164702320155392] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Bone stress injuries can cause long-lasting damage, especially in young athletes and military conscripts, if not diagnosed and treated properly. Diagnosis has been traditionally based on clinical, radiographic and scintigraphic examinations, but MRI has become increasingly important. High resolution MRI is particularly valuable for the grading of bone stress injuries. The clinician should be aware of the wide range of bone stress injuries and available diagnostic methods. Early diagnosis is the prerequisite for avoiding long-lasting complications. Most bone stress injuries heal with closed treatment, but surgery is necessary in some cases. They heal well if the diagnosis is not delayed and the treatment adequate.
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Affiliation(s)
- Jan Lassus
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Finland
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Affiliation(s)
- C Harmath
- Department of Radiology, Loyola University Medical Center, Maywood, Ill 60302, USA
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13
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Affiliation(s)
- M E Schweitzer
- Both authors: Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th St., 3390 Gibbon, Philadelphia, PA 19107, USA
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Abstract
OBJECTIVE To discuss the specific clinical and radiographic features of posterior tibial stress fracture, as well as appropriate clinical management, including imaging and treatment, in the presence of suspected or confirmed tibial stress fracture. CLINICAL FEATURES Three patients suffered from exercise-related lower leg pain, clinical features, and risk factors specific for posterior tibial stress fracture. Diagnosis was confirmed for all three individuals by radiographic imaging. INTERVENTION AND OUTCOME Treatment included rest and modified activity, followed by a graded return to activity commensurate with bony healing. This approach was successful for two of the individuals diagnosed with posterior tibial stress fracture. In the third individual treatment recommendations were not adhered to, resulting in three separate stress fractures of the posterior tibia over 27 months. CONCLUSION Stress fractures may go undiagnosed for a long period of time; therefore a high index of suspicion, along with knowledge of its clinical and predisposing factors, is necessary for recognition. Inappropriate management of individuals with tibial stress fracture may result in recurrence or frank fracture. Chiropractors have a role in the prevention of stress fractures by identifying and educating patients at risk for this condition.
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Affiliation(s)
- G M van der Velde
- Division of Graduate Studies and Research, Canadian Memorial Chiropractic College, Toronto, Ontario
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Abstract
Nuclear medicine provides information about bone physiology that complements anatomic imaging modalities. Following a review of the principles of bone scintigraphy, scintigraphic imaging of orthopedic problems, such as primary and secondary neoplastic disease of the skeleton, occult fracture, stress fracture, and osteomyelitis are discussed.
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Affiliation(s)
- K J Donohoe
- Department of Radiology, Division of Nuclear Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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