Friday, May 23, 2008

Aerobics and a Painful Foot

Jumping around, getting fit, Pilates...Power 90...Tae-Bo...The Firm...take your pick, they all hurt. They are a necessary evil, the price you pay to fit into the same pants you wore ten years ago.

Photo by stilinberlin

Aerobics has been around since the late 1960s. The term was coined by its inventors, Kenneth H. Cooper M.D., an exercise physiologist, and Col. Pauline Potts, a physical therapist. They came up with this form of exercise while in the Air Force, designing exercise regimens for astronauts. They soon realized that this was not simply for the Tang crowd, and published the book "Aerobics" in 1968. It was a smash hit, and the the craze continues.

Like most forms of exercise, overdoing it can result in injury. Fifty-six year old devoted aerobics instructor with several days of midfoot pain, with negative x-rays:

Coronal T2-fatsat image reveals extensive marrow edema (yellow arrow) within the lateral cuneiform. The corresponding axial image confirms the edema, but also depicts a linear, hypointense line (red arrow) within the subchondral bone, adjacent to the joint between the lateral cuneiform and the base of the third metatarsal, defining a subchondral stress fracture.

(A) Sagittal STIR and (B) sagittal T1 images confirm the subchondral stress fracture (red arrows) of the lateral cuneiform.

Subchondral stress fractures can occur in a variety of bones, but are most often found in the knee. Other relatively common locations are the femoral head (where they might explain some cases of transient osteoporosis), and the head of the metatarsals (AJR 2008; 190:570-575).

In my youth, I adhered to the principle, "No pain, no gain" when it came to exercise. In middle age, I have revised this to, "Always pain, minimal gain". This case is a grim reminder of that adage ;-).

Vic David MD

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