The seven footer’s foot

Tuesday, February 26, 2008

7½ feet, 310 pounds. The weight of China on his shoulders. 26 bones, 33 joints, 112 ligaments. Four times the weight of his body with every step. With a stress fracture, Yao Ming’s foot has garnered world attention. Aside from the loss to the Rockets and his Houston teammates, Mr. Ming was the future for Chinese basketball as home team for this year’s Olympics.

While the love affair with basketball shoes had much to do with style over substance, it is the shoes that protect the athlete from potential injury. They cushion the foot as it absorbs four times the body’s weight with each running step (with Ming it’s over half a ton) and saves the small muscles of the foot, the ligaments, the joints and the bones from the trauma with each stride.

The metatarsals are the main target for stress. They are the long bones that form the framework of the foot and the 2nd and 3rd metatarsals are most at risk for stress injury. Anatomically, they are fixed by joints on both ends of the bone, not allowing them the flex that is present for the other three. Metatarsal stress fractures are also known as March fractures because of the frequency in foot soldiers, who are set up for this type of injury: long marches, bad feet and bad shoes.

Overuse is the most common reason for stress fractures. Microscopic cracks occur in the outer cortex of the bone and can cause pain. If it’s ignored and the repetitive activity continues, the injury can become larger. Just like a crack in the windshield of a car, the micro crack of a stress fracture can enlarge and break completely through and through the bone. (For those with vocabulary concerns, fracture break and crack all mean the same thing: the bone’s integrity has been lost.)

The symptoms of a stress fracture are the same as any other bony injury, pain, swelling, and tenderness to touch. The difference is that initial xrays look normal. If after xrays, the diagnosis of a broken bone is still considered, a bone scan or CT may be done to look for the occult or hidden fracture.

The treatment initially is immobilization, rest, ice, elevation and time. Just like a “regular” fracture, it may take weeks to heal. If the bone breaks completely through, surgery may be required. And it seems that surgery may be in Yao Ming’s future. The Rockets and the Chinese basketball world will likely hang on every doctor’s visit or physical therapy session.

Pain is never normal. The elite athlete learns to ignore pain to achieve incredible results. But there is the pain of tired and the pain of injury. Ignoring the first may lead you to Olympic gold, ignoring the second may lead to a seat on the bench.

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