Fractures Flashcards
(93 cards)
1
Q
What tool is used to facilitate examination of the ankles + reduce unnecessary x-rays?
A
These state that x-rays are only necessary if there is pain in the malleolar zone and:
- Inability to weight bear for 4 steps
- Tenderness over the distal tibia
- Bone tenderness over the distal fibula
2
Q
What tool is used to classify fibular fractures?
A
- Type A is below the syndesmosis
- Type B fractures start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
- Type C is above the syndesmosis which may itself be damaged
Syndesmosis = (where tibia + fibula join)
Tibial plafond = articular surface of tibia with the talar bone
3
Q
What is a Maisonneuve fracture?
A
Ankle fracture.
A subtype known as a Maisonneuve fracture may occur with spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required.
4
Q
Rx of ankle fractures
A
Depends upon stability of ankle joint and patient co-morbidities.
All ankle fractures should be promptly reduced to remove pressure on the overlying skin and subsequent necrosis.
Young patients, with unstable, high velocity or proximal injuries will usually require surgical repair. Often using a compression plate.
Elderly patients, even with potentially unstable injuries usually fare better with attempts at conservative management as their thin bone does not hold metalwork well.
5
Q
Paediatric fracture types
What is a complete fracture?
A
Both sides of cortex are breached
6
Q
Paediatric fracture types
What is a Toddlers fracture?
A
Oblique tibial fracture in infants
7
Q
Paediatric fracture types
What is a Plastic deformity?
A
Stress on bone resulting in deformity without cortical disruption
8
Q
Paediatric fracture types
What is a Greenstick fracture?
A
Unilateral cortical breach only
9
Q
Paediatric fracture types
What is a Buckle fracture?
A
Incomplete cortical disruption resulting in periosteal haematoma only
10
Q
In paediatric practice fractures may also involve the growth plate and these injuries are classified according to what system?
A
Salter- Harris system
11
Q
Describe the Salter- Harris system
A
I Fracture through the physis only (x-ray often normal)
II Fracture through the physis and metaphysis
III Fracture through the physis and epiphyisis to include the joint
IV Fracture involving the physis, metaphysis and epiphysis
V Crush injury involving the physis (x-ray may resemble type I, and appear normal)
12
Q
Sx of NAI
A
- Delayed presentation
- Delay in attaining milestones
- Lack of concordance between proposed and actual mechanism of injury
- Multiple injuries
- Injuries at sites not commonly exposed to trauma
- Children on the at risk register
13
Q
What is Osteogenesis imperfecta?
A
- Defective osteoid formation due to congenital inability to produce adequate intercellular substances like osteoid, collagen and dentine.
- Failure of maturation of collagen in all the connective tissues.
- Radiology may show translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis.
- Type I - The collagen is normal quality but insufficient quantity.
- Type II - Poor collagen quantity and quality.
- Type III - Collagen poorly formed. Normal quantity.
- Type IV - Sufficient collagen quantity but poor quality.
14
Q
What is osteopetrosis?
A
- Bones become harder and more dense.
- Autosomal recessive condition.
- It is commonest in young adults.
- Radiology reveals a lack of differentiation between the cortex and the medulla described as marble bone.
15
Q
Name the classification of fractures?
A
Traumatic vs Stress vs Pathological
By type:
Oblique, comminuted, segmental, traverse, Spiral
Open vs Closed
Also by: changes in length of the bone, the angulation of the distal bone, rotational effects, presence of material such as glass.
16
Q
Name the classification of fractures?
A
Traumatic vs Stress vs Pathological
By type:
Oblique, comminuted, segmental, traverse, Spiral
Open vs Closed
Also by: changes in length of the bone, the angulation of the distal bone, rotational effects, presence of material such as glass.
17
Q
Name the classification of fractures?
A
Traumatic vs Stress vs Pathological
By type:
Oblique, comminuted, segmental, traverse, Spiral
Open vs Closed
Also by: changes in length of the bone, the angulation of the distal bone, rotational effects, presence of material such as glass.
18
Q
Fracture lies obliquely to long axis of bone
A
Oblique fracture
19
Q
What is an oblique fracture?
A
Fracture lies obliquely to long axis of bone
20
Q
> 2 fragments
A
Comminuted fracture
21
Q
More than one fracture along a bone
A
Segmental fracture
22
Q
Perpendicular to long axis of bone
A
Transverse fracture
23
Q
Severe oblique fracture with rotation along long axis of bone
A
Spiral fracture
24
Q
What is a Comminuted fracture
A
> 2 fragments
25
What is a Segmental fracture
More than one fracture along a bone
26
What is a Transverse fracture
Perpendicular to long axis of bone
27
What is a Spiral fracture
Severe oblique fracture with rotation along long axis of bone
28
What is the most common classification system for open fractures?
Gustilo and Anderson classification system
29
Name the Gustilo and Anderson classification system
1 Low energy wound <1cm
2 Greater than 1cm wound with moderate soft tissue damage
3 High energy wound > 1cm with extensive soft tissue damage
3 A (sub group of 3) Adequate soft tissue coverage
3 B (sub group of 3) Inadequate soft tissue coverage
3 C (sub group of 3) Associated arterial injury
30
Key points in management of fractures
Immobilise the fracture including the proximal and distal joints
Carefully monitor and document neurovascular status, particularly following reduction and immobilisation
Manage infection including tetanus prophylaxis
IV broad spectrum antibiotics for open injuries
As a general principle all open fractures should be thoroughly debrided ( and internal fixation devices avoided or used with extreme caution)
Open fractures constitute an emergency and should be debrided and lavaged within 6 hours of injury
31
What classification system is used for hip fractures?
The Garden system is one classification system in common use.
Type I: Stable fracture with impaction in valgus.
Type II: Complete fracture but undisplaced.
Type III: Displaced fracture, usually rotated and angulated, but still has bony contact.
Type IV: Complete bony disruption.
The hip is a common site of fracture especially in osteoporotic, elderly females. The blood supply to the femoral head runs up the neck and thus avascular necrosis is a risk in displaced fractures.
32
Management of undisplaced intracapsular fracture with nil comorbidities
Internal fixation (especially if young)
33
Management of Undisplaced intracapsular fracture with Major illness or advanced organ specific disease
Hemiarthroplasty
34
Management of Displaced intracapsular fracture with nil comorbidities
If age <70 then internal fixation (if possible), hip arthroplasty if not
Age >70 total hip arthroplasty
35
Management of Displaced intracapsular fracture in a Major comorbid/ immobile person
Hemiarthroplasty
36
Management of extracapsular fracture (non special type)
Dynamic hip screw
Unless extreme comorbidities
37
Management of Extracapsular fracture
| reverse oblique, transverse or sub trochanteric
Usually intramedullary device
38
Sx of hip fracture
pain
| the classic signs are a shortened and externally rotated leg
39
Name the Gustilo and Anderson system for open fractures
1 Low energy wound <1cm
2 Greater than 1cm wound with moderate soft tissue damage
3 High energy wound > 1cm with extensive soft tissue damage
3 A (sub group of 3) Adequate soft tissue coverage
3 B (sub group of 3) Inadequate soft tissue coverage
3 C (sub group of 3) Associated arterial injury
40
Rx of open fractures
Initial management should focus on careful patient examination to check for associated injuries, control of haemorrhage and the extent of injury. The area should be carefully imaged, distal neurovascular status established the wound covered with a dressing and antibiotics administered. Early debridement is the cornerstone of the management of open fractures. The aim of the debridement is to remove foreign material and devitalised tissue. In most cases the wound is left open. The wound should be irrigated, generally, 6 litres of saline is used. The fracture should be stabilised and an external fixator is often used in the first instance
41
What is a buckle, or torus fracture?
Buckle, or torus, fractures are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They typically occur in children aged 5-10 years.
As they are typically self-limiting they do not usually require operative intervention and can sometimes be managed with splinting and immobilisation rather than a cast.
42
What is a stress fracture
Repetitive activity and loading of normal bone may result in small hairline fractures. Whilst these may be painful they are seldom displaced. Surrounding soft tissue injury is unusual. They may present late following the injury, in which case callus formation may be identified on radiographs. Such cases may not require formal immobilisation, injuries associated with severe pain and presenting at an earlier stage may benefit from immobilisation tailored to the site of injury.
43
What is a scaphoid fracture?
A scaphoid fracture is a type of wrist fracture, typically arises as a result of a fall onto an outstretched hand (FOOSH). This results in axial compression of the scaphoid, with the wrist hyper-extended, and radially deviated. This can also occur during contact sports such as football, or during a road traffic accident due to the patient holding the steering wheel. It is important to examine for scaphoid fractures in anyone presenting with an acutely painful writs for medico-legal reasons. Interestingly patients are more likely to present on Monday, and there are lower rates of presentation over the weekend!
80% of the blood supply is derived from the dorsal carpal branch (branch of the radial artery), in a retrograde manner. Interruption of the blood supply risks avascular necrosis of the scaphoid, with this most commonly complicating proximal injuries.
44
Epidemiology of a scaphoid fracture
Males are at increased risk of fracture (7M:1F).
The average age of the patient is 22 years old (9 to 35 years old).
The reported incidence for fracture of the scaphoid is 12.4 per 100,000
45
Sx of scaphoid fracture
Pain along the radial aspect of the wrist, at the base of the thumb
Loss of grip / pinch strength
[1] Point of maximal tenderness over the anatomical snuffbox1: This is a highly sensitive, but poorly specific test in isolation.
[2] Wrist joint effusion1: Hyper acute injuries (<4hrs old), and delayed presentations (>4days old) may not present with joint effusions.
[3] Pain elicited by telescoping of the thumb (pain on longitudinal compression)
[4] Tenderness of the scaphoid tubercle (on the volar aspect of the wrist)
[5] Pain on ulnar deviation of the wrist
TO FIND THE SCAPHOID TUBERCULE: get the patient to resist extension whilst pressing the carpi bone of the index finger. You will find the flexor carpi radialis tendon -> follow this up to the first bony prominence. Get the patient to ulnar+then radial deviate the wrist - if it moves its the scaphoid
46
Ix for scaphoid fracture
Investigations:
Plain film radiographs should be requested of the wrist in the anterior-posterior view, and lateral view. Scaphoid views should always be requested when a fracture is suspected. Radiographs should be repeated two weeks later when a scaphoid fracture is diagnosed, or where initial radiographs are inconclusive, but the clinical features are strongly suggestive of a scaphoid fracture.
A CT scan is superior to plain film radiographs, and may be requested in the context of planning operative management, or to determine the extent of fracture union during follow-up.
MRI is considered the definite investigation to confirm or exclude a diagnosis, and despite variation in practice between healthcare trusts, it is the most common second line imaging modality employed.
47
Fall onto extended outstretched hand
3 features:
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation
Colles' fracture (dinner fork deformity)
48
What are the features of Colles' fracture (dinner fork deformity)
Fall onto extended outstretched hand
Classical Colles' fractures have the following 3 features:
1. Transverse fracture of the radius
2. 1 inch proximal to the radio-carpal joint
3. Dorsal displacement and angulation
49
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
Smith's fracture (reverse Colles' fracture)
50
What are the features of Smith's fracture (reverse Colles' fracture)
Volar angulation of distal radius fragment (Garden spade deformity)
Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
51
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal
Bennett's fracture
52
What are the features of Bennett's fracture
Intra-articular fracture of the first carpometacarpal joint
Impact on flexed metacarpal, caused by fist fights
X-ray: triangular fragment at ulnar base of metacarpal
53
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability
Monteggia's fracture
54
What are the features of Monteggia's fracture
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Fall on outstretched hand with forced pronation
Needs prompt diagnosis to avoid disability
55
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow
Galeazzi fracture
56
What are the features of Galeazzi fracture
Radial shaft fracture with associated dislocation of the distal radioulnar joint
Direct blow
57
Bimalleolar ankle fracture
| Forced foot eversion
Pott's fracture
58
What are the features of Pott's fracture
Bimalleolar ankle fracture
| Forced foot eversion
59
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
Barton's fracture
60
What are the features of Barton's fracture
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
Fall onto extended and pronated wrist
61
What are the features of Radial head fracture
Fracture of the radial head is common in young adults.
It is usually caused by a fall on the outstretched hand.
On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
62
Fracture of the radial head is common in young adults.
It is usually caused by a fall on the outstretched hand.
On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).
Radial head fracture
63
List the causes of pathological fractures?
Metastatic tumours
Bone disease eg Osteogenesis imperfecta, Osteoporosis, Metabolic bone disease, Paget's disease
Local benign conditions eg chronic osteomyelitis / bone cyst
Primary malignant tumours eg chondrosarcoma, osteosarcoma, ewings tumour
64
Who should be assessed for osteoporosis and fragility fractures?
NICE advise that all women aged >= 65 years and all men aged >= 75 years should be assessed. Younger patients should be assessed in the presence of risk factors, such as:
previous fragility fracture
current use or frequent recent use of oral or systemic glucocorticoid
history of falls
family history of hip fracture
other causes of secondary osteoporosis
low body mass index (BMI) (less than 18.5 kg/m²)
smoking
alcohol intake of more than 14 units per week for women and more than 14 units per week for men.
65
What tools are used to assess a patients 10 year risk of developing a fracture?
FRAX + Q fracture
FRAX
estimates the 10-year risk of fragility fracture
valid for patients aged 40-90 years
based on international data so use not limited to UK patients
assesses the following factors: age, sex, weight, height, previous fracture, parental fracture, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, alcohol intake
bone mineral density (BMD) is optional, but clearly improves the accuracy of the results. NICE recommend arranging a DEXA scan if FRAX (without BMD) shows an intermediate result
QFracture
estimates the 10-year risk of fragility fracture
developed in 2009 based on UK primary care dataset
can be used for patients aged 30-99 years (this is stated on the QFracture website, but other sources give a figure of 30-85 years)
includes a larger group of risk factors e.g. cardiovascular disease, history of falls, chronic liver disease, rheumatoid arthritis, type 2 diabetes and tricyclic antidepressants
If the FRAX assessment was done without a bone mineral density (BMD) measurement the results (10-year risk of a fragility fracture) will be given and categorised automatically into one of the following:
low risk: reassure and give lifestyle advice
intermediate risk: offer BMD test
high risk: offer bone protection treatment
Therefore, with intermediate risk results FRAX will recommend that you arrange a BMD test to enable you to more accurately determine whether the patient needs treatment
If the FRAX assessment was done witha bone mineral density (BMD) measurement the results (10-year risk of a fragility fracture) will be given and categorised automatically into one of the following:
reassure
consider treatment
strongly recommend treatment
66
Who gets BMD assessment with DEXA scan?
before starting treatments that may have a rapid adverse effect on bone density (for example, sex hormone deprivation for treatment for breast or prostate cancer).
in people aged under 40 years who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer).
67
What are the NICE guidelines on the secondary prevention of osteoporotic fractures in postmenopausal women?
Key points include
treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below). In women aged 75 years or older, a DEXA scan may not be required 'if the responsible clinician considers it to be clinically inappropriate or unfeasible'
vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
alendronate is first-line
around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate (see treatment criteria below)
strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates (see treatment criteria below)
68
has been shown to prevent bone loss and to reduce the risk of vertebral fractures, but has not yet been shown to reduce the risk of non-vertebral fractures
has been shown to increase bone density in the spine and proximal femur
may worsen menopausal symptoms
increased risk of thromboembolic events
may decrease risk of breast cancer
Raloxifene - selective oestrogen receptor modulator (SERM)
69
'dual action bone agent' - increases deposition of new bone by osteoblasts (promotes differentiation of pre-osteoblast to osteoblast) and reduces the resorption of bone by inhibiting osteoclasts
concerns regarding the safety profile of strontium have been raised recently. It should only be prescribed by a specialist in secondary care
due to these concerns the European Medicines Agency in 2014 said it should only be used by people for whom there are no other treatments for osteoporosis
increased risk of cardiovascular events: any history of cardiovascular disease or significant risk of cardiovascular disease is a contraindication
increased risk of thromboembolic events: a Drug Safety Update in 2012 recommended it is not used in patients with a history of venous thromboembolism
may cause serious skin reactions such as Stevens Johnson syndrome
Strontium ranelate
70
human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts
given as a single subcutaneous injection every 6 months
initial trial data suggests that it is effective and well tolerated
Denosumab
71
recombinant form of parathyroid hormone
| very effective at increasing bone mineral density but role in the management of osteoporosis yet to be clearly defined
Teriparatide
72
Sport injury
Mechanism: high twisting force applied to a bent knee
Typically presents with: loud crack, pain and RAPID joint swelling (haemoarthrosis)
Poor healing
Management: intense physiotherapy or surgery
Ruptured anterior cruciate ligament
73
Mechanism: hyperextension injuries
Tibia lies back on the femur
Paradoxical anterior draw test
Ruptured posterior cruciate ligament
74
Mechanism: leg forced into valgus via force outside the leg
| Knee unstable when put into valgus position
Rupture of medial collateral ligament
75
Rotational sporting injuries
Delayed knee swelling
Joint locking (Patient may develop skills to 'unlock' the knee
Recurrent episodes of pain and effusions are common, often following minor trauma
Menisceal tear
76
Teenage girls, following an injury to knee e.g. Dislocation patella
Typical history of pain on going downstairs or at rest
Tenderness, quadriceps wasting
Chondromalacia patellae
77
Most commonly occurs as a traumatic primary event, either through direct trauma or through severe contraction of quadriceps with knee stretched in valgus and external rotation
Genu valgum, tibial torsion and high riding patella are risk factors
Skyline x-ray views of patella are required, although displaced patella may be clinically obvious
An osteochondral fracture is present in 5%
The condition has a 20% recurrence rate
Dislocation of the patella
78
i. Direct blow to patella causing undisplaced fragments
Or
ii. Avulsion fracture
Fractured patella
79
Occur in the elderly (or following significant trauma in young)
Mechanism: knee forced into valgus or varus, but the knee fractures before the ligaments rupture
Varus injury affects medial plateau and if valgus injury, lateral plateau depressed fracture occurs
Classified using the Schatzker system (see below)
Tibial plateau fracture
80
What classification system is used for tibial plateau fractures
Schatzker Classification system for tibial plateau fractures
1 Vertical split of lateral condyle Fracture through dense bone, usually in the young. It may be virtually undisplaced, or the condylar fragment may be pushed inferiorly and tilted
2 Vertical split of the lateral condyle combined with an adjacent load bearing part of the condyle The wedge fragment (which may be of variable size), is displaced laterally; the joint is widened. Untreated, a valgus deformity may develop
3 Depression of the articular surface with intact condylar rim The split does not extend to the edge of the plateau. Depressed fragments may be firmly embedded in subchondral bone, the joint is stable
4 Fragment of the medial tibial condyle Two injuries are seen in this category; (1) a depressed fracture of osteoporotic bone in the elderly. (2) a high energy fracture resulting in a condylar split that runs from the intercondylar eminence to the medial cortex. Associated ligamentous injury may be severe
5 Fracture of both condyles Both condyles fractured but the column of the metaphysis remains in continuity with the tibial shaft
6 Combined condylar and subcondylar fractures High energy fracture with marked comminution
81
Very common. Usually through the surgical neck. Number of classification systems though for practical purposes describing the number of fracture fragments is probably easier. Some key points:
It is rare to have fractures through the anatomical neck.
Anatomical neck fractures which are displaced by >1cm carry a risk of avascular necrosis to the humeral head.
In children the commonest injury pattern is a greenstick fracture through the surgical neck.
Impacted fractures of the surgical neck are usually managed with a collar and cuff for 3 weeks followed by physiotherapy.
More significant displaced fractures may require open reduction and fixation or use of an intramedullary device.
Proximal humerus fractures
82
Which Proximal humerus fractures can cause avascular necrosis?
Anatomical neck fractures which are displaced by >1cm carry a risk of avascular necrosis to the humeral head.
83
Name the 3 types of shoulder dislocation (not directional)
```
Glenohumeral dislocation (commonest): anterior shoulder dislocation most common
Acromioclavicular dislocation (12%): clavicle loses all attachment with the scapula
Sternoclavicular dislocation (uncommon)
```
84
Most common type of shoulder dislocation
```
Glenohumeral dislocation (commonest): anterior shoulder dislocation most common
Acromioclavicular dislocation (12%): clavicle loses all attachment with the scapula
Sternoclavicular dislocation (uncommon)
```
85
External rotation and abduction
35-40% recurrent (it is the commonest disorder)
Associated with greater tuberosity fracture, Bankart lesion, Hill-Sachs defect
Anterior shoulder dislocation
86
Luxatio erecta
Inferior shoulder dislocation
87
Proportion misdiagnosed.
Rim's sign, light bulb sign.
Associated with Trough sign
Posterior shoulder dislocation
88
Rare and usually follow major trauma.
Superior shoulder dislocation
89
Rx of shoulder dislocation
Prompt reduction is the mainstay of treatment and is usually performed in the emergency department. Neurovascular status must be checked pre and post reduction and x-rays should be performed again post reduction to ensure no fracture has occurred. In recurrent anterior dislocation there is usually a Bankart lesion and this may be repaired surgically. Recurrent posterior dislocations may be repaired in a similar manner to anterior lesions but using a posterior (or arthroscopic) approach.
90
Osteoporosis RFs
```
The major risk factors for osteoporosis are age and female gender. Other risk factors include:
corticosteroid use
smoking
alcohol
low body mass index
family history
```
91
What is a Lisfranc injury?
Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus
Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents
According to a 1997 study, for severe Lisfranc injuries, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire fixation is the treatment of choice
92
Rx of a Lisfranc injury
Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus
Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents
According to a 1997 study, for severe Lisfranc injuries, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire fixation is the treatment of choice
93
What is a metatarsal stress fracture?
A metatarsal stress fracture is a hairline fracture in one of the long metatarsal bones in the foot. They occur through overuse or poor foot biomechanics. The second metatarsal is the bone most commonly injured.
CAUSE - Overuse! They are common in army recruits (often called a march fracture), runners, ballet dancers, and gymnasts. Repetitive strain on the bone eventually results in a stress fracture.
Overpronation – where your foot rolls in too much, or flattens.
Oversupination – where your foot has a particularly high arch. This means it is rigid and does not pronate (roll in) enough to absorb the forces from running.
Rx: REST, MAY NEED ORTHOTICS
