A Guide to Stress Fractures with Dr. Ronald Derr – Facebook Live

Dr. Derr, Tell Us A Little Bit About Yourself And What Specialties You See Here At Bone And Joint Institute:

Dr. Ronald Derr: I’ve been here with this group 27 years, so I’m part of the old guard here. I’ve seen a lot of changes over the years, but it’s been a great practice to be with. In addition to helping with the patient care here, I also take care of the sports teams at Ravenwood High School and cover their sports programs. All of us here take on one of the schools in the county, and that has been mine. It has been a great experience there. We see a lot of athletic injuries, but we see a lot of weekend athletes as well. 

What Is A Stress Fracture and Who Can Get A Stress Fracture?

Dr. Derr: A stress fracture can be obtained by anybody who’s active. It’s an overuse injury of the bone where the healing processes are not keeping up with the breakdown. Bones are always remodeling and healing and so when we put them through a stressful activity such as running or jumping, court sports, anything that really puts demand on your foot, there’s always a remodeling process that is in action. Sometimes the healing is not keeping up with the breakdown or destruction, and so overtime that can weaken the bone to the point where it can become injured or fractured from that activity.

You’ve Described It Before Like A Paper Clip, Is That Correct?

Dr. Derr: Yes, I tell people if you take a paper clip and bend it back and forth long enough, it’s going to gradually weaken and break. That’s basically the same idea with a bone. Bone has some elasticity to it. It can take on a fair amount of stress and accommodate that, but when it gets to a point when that happens too often and too long and it has not had a chance to recover and rest, there’s going to be an injury.

How Do You Diagnose A Stress Fracture?

Dr. Derr: Probably the most common reason we look for a stress fracture is suspicion based on complaints of pain and swelling, but most often it’s a diagnosis of suspicion. With the activities that people do – especially the half marathon and marathon recently and all the training and extensive amount of activity that goes with that, the training that leads up to it and the actual event – it just puts you at a higher risk of those sorts of injuries coming on.

What Are Typical Treatments for a Stress Fracture?

Dr. Derr: We like to catch it early, so if there’s pain or suspicion of an injury, we’d rather have people come in and get a evaluated sooner than later. If you can catch it early enough, a lot of times it’s just easier to heal and recover from if you can catch it before it becomes an actual fracture. An injury could be there, we may not see anything on an X-ray but we know from the activity and from the description of the symptoms and findings we see on exam that that’s probably the most likely scenario. We can rest it with what we call active rest where you don’t have to be immobilize so much, but we have to avoid the activity that’s causing the injury for a while. If we actually see a fracture, it’s going to be a more extensive recovery where you are actually in a boot or a cast for 6 to 8 weeks.

Is Surgery An Option For A Stress Fracture?

Dr. Derr: Very seldom does surgery become an option, but certain bones in the foot have a higher risk of nonunion, or not healing. Some bones such as the navicular bone or sometimes a fifth metatarsal fracture in an athlete, we are more aggressive and may require operation to stabilize it to minimize the risk of that becoming a worse injury by not healing. But in general, stress fractures are injuries that heal without surgery.

What Are Some Good Prevention Tips for Stress Fractures?

Dr. Derr: I think the biggest point I would encourage people to do is go slow as far as how you jump into an activity. It’s not so much the activity, sometimes it’s the training errors that we see where people go way to aggressively into an activity and don’t acclimate to it either because of the length of time they were doing it or the intensity they are participating in. Sometimes it’s a terrain issue if you’re doing a lot of hills instead of flat work, or if you were running on asphalt instead of a path or track that has a little bit of give to it that allows a little more cushion for your foot. Sometimes those training errors can be the biggest reason these injuries come on. 

Can You Talk A Little Bit About How The Comprehensive Care at Bone and Joint Institute Really Helps The Patient From Start To Finish?

Dr. Derr: The benefit we have here, it’s been a great, great practice for years and we’ve developed a great facility here and outreach programs with our outreach clinics. But we have the advantage here of 15 doctors working together, so if we have any issues outside of our comfort zone we all have the ability to communicate with each other to share and discuss cases. We also have the benefit in a facility such as this to have physical therapy available to us here or at our outreach clinics. We have imaging in the building with MRI and CAT scans that we use to help with diagnosis to define what we’re treating. Then we have the surgery center built into this building as well. If it ever did become an issue where surgery was indicated or necessary, we can do everything in this one facility. It’s really quite extensive what we can do here.

To watch the full segment with Dr. Derr from Facebook Live, click here.

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