Bone Health in the Sporting Foot

This session included presentations on: Bone health and resilience: what you need to know; Assessing bone and monitoring healing: the role of the radiologist; Assessing bone and monitoring healing: the role of the physician; An explanation of the best ways to manage the common injuries conservatively; Surgery for commonly seen stress fractures in the foot and when to choose that path; and Milestones for returning to activity after stress fractures in the foot and ankle.

Bone resilience is the ability of bone to resist and adapt to multiple, varied loading stresses on repeated occasions over sustained periods. It is multifactorial, dependent upon the ability to recover, remodel and adapt to loading cycles, which can be highly variable between different individuals. All factors affecting bone resilience need to be considered and individualised training and recovery periods may be needed. As plain radiographs are quite insensitive for bone stress fractures, there is a low threshold for MRI. CT can be useful post-ORIF (open reduction internal fixation). The physician has a number of roles including ensuring there is no secondary cause for the fracture, optimising calcium and vitamin D levels, monitoring healing as well as medical treatment of the fracture. Most common bone injuries will respond well to conservative management, which requires an accurate diagnosis, recognition of high-risk/sinister injuries and recognition of the high-risk patient (athlete triad). Conservative treatment involves management by a multidisciplinary team, withdrawal from training if necessary, ensuring a safe environment for recovery, and aiming to regain positive energy balance, hormonal function, behaviours. When to opt for surgery for foot and ankle stress fractures at a number of sites was discussed, including the lesser metatarsals, the 5th metatarsal, as well as sesamoid, navicular and medial malleolar stress fractures. Common themes included surgery for delayed/non-union and a lower threshold for surgery in athletes/active patients. For effective return to activity rehab it is crucial for the therapist and the patient to understand the principles of load, consequences of load from walking/carrying/running/jumping and to have a very careful progression of activity. Literally, do not run before you can walk!