Surgical Services Stress Fractures Stress fractures or "fatigue" fractures commonly occur in the foot and leg. A stress fracture usually presents itself in an individual who is new to exercise or has increased his/her exercise regiment, has started wearing new or different shoes, has started walking on a different flooring as in a new or different job and/or has had an increase in body weight. Early diagnosis and treatment of the stress fracture or bone inflammation is important, because the fissure may slowly expand across the entire bone. Treatment consists of decreasing activity, wearing a metatarsal shoe, compression dressing, icing, anti-inflammatories, off-weightbearing excercises and in some cases casting. In mild situations or when the stress fracture starts to heal, Dr. Sobel will fit you for custom functional foot orthoses. Jones Fracture (5th Metatarsal Fracture) Patients who sustain a Jones fracture have pain over this middle/outside area of their foot, swelling, and difficulty walking. In some cases, a screw will be placed across the fracture site starting from the base of the 5th metatarsal, through the fractured region to compress the fracture site to facilitate healing by stabilizing the fracture and reducing the fracture gap between the bone ends Lisfranc Fracture Actually a fracture and dislocation, this is an injury to a joint in the midfoot. Lisfranc injuries occur at the midfoot, where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. From this cluster, five long bones (metatarsals) extend to the toes. The second metatarsal also extends down into the row of small bones and acts as a stabilizing force. The bones are held in place by connective tissues (ligaments) that stretch both across and down the foot. However, there is no connective tissue holding the first metatarsal to the second metatarsal. A twisting fall can break or shift (dislocate) these bones out of place. Often, operative treatment is needed to stabilize the bones and hold them in place until healing is complete. Congenital Foot Deformities For most common deformities, optimal results occur when casting is begun between 3-8 months of age, although casting has been shown to be somewhat effective up to 2 years of age. Typical treatment involves a short leg cast changed every 1-2 weeks, for a total of 6-12 weeks. Recurrence is uncommon. Dr. Sobel will usually prescribe a followup treatment consisting of stretching and either supportive shoes or orthotics. Arthritis If bone on both sides of the joint is damaged, Dr. Sobel may have to remove a small portion of cartilage and bone, then reconstruct the ligaments and tendons. Fusion or arthrodesis relieves pain by uniting the bones of the joint into a permanent, yet useful position, preventing any motion at the site. In extreme circumstances, complete reconstruction of the joint may be necessary. In this case, Dr. Sobel will replace the joint with an implanted prosthetic joint.