Biden Gets Foot Stress Fracture Playing with Dog, How Common is This?

Biden Fractures his Foot Playing with dog

 

About a week ago, while playing with his dog Major, Joe Biden slipped and twisted his ankle. The pain was severe enough to get him to his long-term family doctor, Kevin O’Connor. The next day, “out of an abundance of caution”, Biden visited a specialist in Newark, Delaware.

X-rays initially showed no sign of a fracture, but the history of the incident, coupled with Biden’s symptoms, were serious enough to warrant further diagnostic investigation. Sure enough, a CT scan confirmed hairline fractures of President-elect Biden’s lateral and intermediate cuneiform bones.

There hasn’t been much detail released about the treatment that Biden will receive, but it is known that he’ll be in a walking boot for several weeks, and his weight-bearing activity will be limited. Given his current situation, it’s going to be difficult for Biden to reduce his daily activity.

What’s the difference between a stress fracture and a hairline fracture?

Whether it’s called a stress fracture or a hairline fracture, the net result is the same: an inconspicuous small crack in a bone. The only real difference between the two is the causative factor.

Who are at risk of stress fractures? 

A stress fracture is generally an overuse injury. The risk factors that contribute to stress fractures are participation in activities that overload the foot’s structure.

Stress fractures of the foot are most commonly suffered by ballet dancers, members of a marching band, and participants in high-impact sports, like gymnastics, track and field, long-distance running, and soccer.

A hairline fracture is usually the result of sudden trauma. Hairline fractures occur randomly, and to anyone, as shown by the President-elect’s example.

What else creates an increased risk of hairline fractures in the foot?

Biden will be 78 years old when he is inaugurated on January 20, 2021, and advancing age tends to reduce the production of healthy new bone. This can lessen bone density, which can in turn lead to a condition known as osteoporosis. Porous bones are fragile bones, and fragile bones are more susceptible to tiny cracks.

Shortages of vitamin D and calcium can also increase the possibility of both hairline fractures and stress fractures.

Structural foot defects, like the painful misalignments of the big toe joint known as bunions, can also contribute to increased incidents of small fractures in the foot.

What are lateral and intermediate cuneiform bones?

The two long bones in the lower leg are called the fibula and the tibia. They connect to the two largest bones of the ankle: the talus and the calcaneus. Next in order comes another large bone, the navicular.

If you’ve ever given a really good foot massage, you’ll know that there are five long skinny bones that run between your loved ones’ ankles and toes. Those are the metatarsals.

Just behind the metatarsals (i.e., toward the ankle) is a row of four roughly cubical lumps of bone, about the right size to load a slingshot. The small bone on the outside edge of the row is called the cuboid bone. The other three lumps in the row are the cuneiform bones. These hunks of bone, and the webs of ligaments that surround and bind them, are vital components of the awesomely intricate architecture of the foot.

Biden managed to slightly fracture his lateral and medial cuneiforms, while somehow leaving the one in the middle intact.

What is the treatment for hairline fractures in the foot? 

The current medical advice is to wear protective footwear, like Biden’s walking boot, and cut down on physical activity, while taking analgesic NSAIDs, like ibuprofen, to reduce pain and inflammation.

What is a Lisfranc injury?

There is a very real danger that an injury like Biden’s will also entail a condition known as a Lisfranc injury. That’s a misalignment between a cuneiform bone and its corresponding metatarsal bone. If uncorrected, this maladjustment will eventually lead to erosion of the joint, arthritis, and a lot of debilitating pain.

A Lisfranc injury occurs when a violent wrenching force disrupts the structure of the midfoot. The condition is named after a French surgeon named Jacques Lisfranc de St. Martin, who served in Napoleon’s army.

The sort of force that results in disruption of the bones and ligaments of the midfoot was all too common among the Napoleonic cavalry. It frequently happened during battle, when a horseman was thrown from his saddle and fell to the ground, while his foot remained in the stirrup of his saddle. Ouch.

We’re sure that Biden’s doctors have been alert to the possibility that he suffered a Lisfranc injury.

Why wasn’t an x-ray good enough to diagnose a hairline fracture?

There was a significant delay between Biden’s injury and the ultimate diagnosis of hairline fractures in his cuneiform bones. Such a delay in the detection of tiny cracks amongst the 26 bones in the human foot is not unusual.

A hairline fracture is, as indicated by its name, extremely narrow. The affected bone, although broken, is still perfectly aligned. So an x-ray often fails to display a fracture, even to the eyes of a skilled radiologist.

Compared to an x-ray, a CT bone scan is a far more penetrating and illustrative diagnostic tool. (The “CT” is short for computed tomography.) A CT scan produces a three-dimensional image, composed by a computer from 100 or so x-rays, taken from an all-encompassing 360° perspective.

So, when Biden’s doctors were viewing a CT scan of his foot and ankle, they saw a much more detailed view than had been produced by the earlier ordinary x-ray. They were able to look at highly detailed 3D images of the interior of the damaged foot, and they could see those images from any angle. CT scans are more expensive than traditional x-rays, but we’re pretty sure Biden’s health care insurer won’t deny the claim.

Images taken via magnetic resonance imaging (MRI) can also assist in diagnosing hairline and stress fractures.

Is Biden’s dog Major in trouble? 

Major is one of the Bidens’ two German shepherds. The other is named Champ. Champ was recruited into the Biden family during the presidential transition in December 2008, a couple of weeks after the Obama/Biden ticket prevailed electorally, and a few weeks before the 2009 inauguration.

So Champ got to live for eight years at Number One Observatory Circle, the official residence of the Vice President, located in northeast Washington D.C.

Big deal, Champ. Major will soon have the splendid honor of being the first rescue pet to hang out in and around the White House.

President-elect Biden first discovered Major in 2018, at the Delaware Humane Association. Major was initially fostered. However, when the Bidens proved suitable, Major graciously accepted full membership in the family. It is strongly rumored that Champ and Major will be joined by a cat in the White House.

When asked if he feared potential retaliation for his share of the responsibility for Biden’s injury, Major shrugged off the question. “Joe’s a nice guy, and he doesn’t hold grudges. Anyway, I’ve probably been headed for the dog-house for a while. I’ve been pretty vocal about my position on the cat.”

Why choose University Foot and Ankle Institute for your foot care?

If you’re experiencing foot pain or other foot problems, we’re here to help. Our nationally recognized foot and ankle doctors offer the most advanced foot care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.

At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.

For more information or to schedule a consultation in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia California, to name a few.

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