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Stress Fractures in Women Tied to Shoes, Eating.

KANSAS CITY, MO. -- The first places to look for the cause of a stress fracture in a female runner are her shoes and her dinner plates, Dr. Lisa R. Callahan said at a meeting on sports medicine sponsored by the American Academy of Family Physicians.

"Stress fractures result from abnormal stress on abnormal bones," said Dr. Callahan, medical director of the Women's Sports Medicine Center at the Hospital for Special Surgery, New York.

Abnormal stress can come from running too much; the risk goes up precipitously in those who run 30 miles per week or more.

It also comes from running on shabby shoes that have had their cushioning stamped out of them.

That's why the evaluating physician should ask about the patient's running shoes and be sure that she is changing them at least every 350 miles, Dr. Callahan commented.

The second part of the picture--abnormal bones--can be harder to elucidate, she noted.

Disordered eating, which is very common in serious female athletes, often is a cause of calcium deficiency and osteoporosis leading to brittle bones. But disordered eating in these women can be subtle and insidious, often not rising to the level of a full-blown eating disorder like anorexia nervosa or bulimia.

In a recent study, one-third of female college athletes had practiced at least one form of disordered eating within the past month, including fasting, vomiting, or diuretic or laxative use. The data were selfreported, so the study probably underestimated the true incidence of disordered eating in female athletes.

People often hide disordered eating, just as they do alcoholism, "so you can probably go and double the numbers," Dr. Callahan said.

She also gave advice on managing other common lower extremity injuries in female athletes:

* Anterior Cruciate Ligament Tears. Women athletes get more ACL tears than their male counterparts do, although no one knows why.

"Plant and cut" motions with the foot, straight-knee landings, and one-leg takeoffs when jumping are the most common activities that tear the ACL. That makes basketball, soccer, skiing, and racquet sports the riskiest activities.

Many physicians refer ACL tears to surgery upon diagnosis, but physical therapy has progressed to the point where surgery may no longer always be indicated. In nonelite athletes who have more time for recovery a rehabilitation program that addresses proprioception and strength can "usually get them back to where they want to be," she said.

* Patellofemoral Pain. This term actually represents a broad range of possible underlying causes. The first clinical task is to determine if the pain stems from a hypermobile or a tight patella.

A patella apprehension test is one of the best ways to assess the problem. With the patient lying on her back and with the affected leg extended, gently use the thumbs to push the patella laterally. If the patient tries to stop the maneuver for fear that the bone will pop out, it is highly suggestive of a hypermobile patella, Dr. Callahan said.

Most cases of hypermobile patella are best managed with passive restraint in the form of a Chopart's strap or a parellar brace that can help keep the patella in the trochlear groove. An exercise program to strengthen the vastus medalis oblique also is useful.

A tight patella only gets worse with a brace, so passive modalities should be used instead. Iliotibial band stretches can help loosen the patella and its lateral structures. "These people are good candidates for physical therapy," she said.
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Publication:Family Practice News
Date:Jun 1, 1999
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