Risk and grade of foot and ankle stress fractures guide treatment

Ortho Supersite—March 9, 2009   

Diagnosing foot and ankle stress fractures rapidly and accurately provides athletes with the best chance for quick and safe return to play, according to an orthopedist from Hospital for Special Surgery in New York.

During the American Orthopaedic Society for Sports Medicine 2009 Specialty Day Meeting, held here, Russell F. Warren, MD, team physician for the New York Giants football team, described an algorithm he has found helpful for determining whether his patients need to discontinue their activities or if they require surgery.

“Think about these fractures as being either high-risk or low-risk,” Warren told the sports medicine orthopedists specializing in foot and ankle care. High-risk stress fractures tend to be caused by tension and occur in the anterior tibia, which he referred to as the “black line,” as well as the malleolus, tibia, navicular and fifth metatarsal. In contrast, low-risk fractures are usually compression fractures, he said.

Using grades 1 to 4 to classify stress fractures in combination with their high - or low- risk status helps surgeons manage them, Warren noted. Grades 1 and 2 correspond to fractures with normal radiographs, while grades 3 and 4 describe partial and complete fractures, respectively.

Warren reviewed a few approaches to managing foot and ankle stress fractures, some of which have variable scientific validity or are new. They included modifying foot wear, recommending orthotics, addressing the patient’s bone quality, using electrical bone stimulation and prescribing bisphosphonates to boost fracture healing in high-risk cases.

Read the full summary of Dr. Warren's presentation: How do we get these patient back on the field the quickest?, presented at the American Orthopaedic Society for Sports Medicine 2009 Specialty Day Meeting on Feb. 28, 2009 in Las Vegas at Orthosupersite.com.