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Joe Biden's Foot Fracture Highlights Fragility of Those Bones

As people age, the 26 bones in our feet are more at risk

Joe Biden waves to a crowd

Alex Wong/Getty Images

En español | Joe Biden was playing with one of his German shepherds last weekend when he broke small bones in his foot.

It might sound unlikely that such an innocuous action could end in fractures, but experts say that it is common for people over 50 to suffer foot and ankle injuries doing everyday activities.

It's often something simple, like tripping on a tree root while working in the yard or slightly twisting an ankle when carrying a laundry basket down a set of stairs. Sometimes just stepping off a curb will result in a hairline fracture in one of the foot's 26 bones, according to Anne Sharkey, a podiatrist who practices near Austin, Texas.

"It's like the straw that breaks the camel's back,” says Sharkey, who treats mostly seniors. “The bones and the joints are weakened over time, and then an incident occurs that turns it into an acute fracture."

As with the president-elect, the injury is often diagnosed as a sprain based on an X-ray. After a day or two, when the pain and swelling do not subside, a specialist will use a CT scan that reveals a small, hairline fracture.

This week Biden's press office released a statement from his doctor that the president-elect has small fractures in the middle of his foot. Such injuries are more common in football players and other athletes, Sharkey said. The most common hairline fractures are in the toes.


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After an orthopedist diagnosed Biden's hairline fracture, he sent the president-elect home wearing a walking boot. The boot has become the standard treatment for a range of foot and ankle injuries because it compresses the injured foot to reduce swelling while keeping the bones in a fixed position. It also keeps the patient mobile enough to continue everyday activities. Biden's press team said he will be wearing the boot for several weeks.

Many people with hairline fractures wear boots for six to eight weeks, Sharkey said. The long end of that timeline is right after Inauguration Day. It is almost certain that Biden, 78, will be the first president to take the oath of office wearing a mask. There is a chance he will also be the first one to be wearing a walking boot.

Waning bone density can contribute

Biden broke the lateral and intermediate cuneiform bones, which are in the middle of the foot. The foot is a complex network of small bones connected by 30 ligaments. The feet bear weight with every step, and over time the stress accumulates and can result in an unexpected injury.

"It's natural wear and tear,” Sharkey said. “When you put a lot of miles on your feet, something's going to happen.”

In addition, everyone loses bone density and muscle mass as they age. As a result, the ability to keep your balance declines, as does the reaction time that can prevent a fall, says Jasmine Marcus, a physical therapist in Ithaca, New York. All of those things make injuries more likely, Marcus says.

Those factors come into play even for healthy and active adults like the president-elect, whose doctor reported in 2019 that Biden has “no significant history of diseases” and works out at least five times a week.

Physical therapy on the road to recovery

As you recover from a foot injury, your physical therapy will focus first on working on balance and increasing the range of motion, Marcus said. Once those are established, the therapist will work to strengthen the muscles around the ankles and feet. The therapy will be designed to get the patient back to doing the activities they enjoy.

"Biden is pretty active and on his feet a lot,” she says. “He likes to run on stage. It appears that he's trying to show he's very physically fit."

As with any injury, patience and doing daily exercises recommended by a physical therapist are key.

Don't Let It Happen to You

While broken bones and other foot injuries are common, they can be prevented with the right combination of exercise, diet and proper shoes. These preventive steps are especially important for women, who are more likely than men to lose bone density.

Minimize high-impact exercise. Running, tennis, basketball and ballet are great for cardio fitness and muscle development. But the constant pounding on the feet takes a toll, leading to a weakening of bones in the foot.

Cross-train. Low-impact activities such as cycling, rowing and using an elliptical have the cardio benefits of high-impact activities, but they don't put the same amount of pressure on the delicate bones in your feet. In addition, Sharkey recommends using light weights to stave off the decline in muscle mass.

Stretch across legs and feet. Staying limber, especially in the calves, protects the bones. Sharkey recommends a stretch where you lean again a wall from about two feet away. Put the toes of one foot against the wall while pressing through the other foot and moving your hips forward. And do not stop after 30 seconds. “You need to hold that stretch for 10 to 15 minutes a day,” says Sharkey, especially if you're recovering from an injury.

Take your vitamins. Vitamin D and calcium deficiencies are directly linked to broken bones. Sharkey recommends getting a Vitamin D screening at your annual physical.

Wear the right shoes. Tight shoes will compress nerves in your feet, making them vulnerable to injury. Make sure you have enough arch support. Replace worn running and walking shoes to ensure the feet have enough cushioning on impact.

Get out of your slippers. Sharkey says she is seeing an increase in Achilles tendonitis during the coronavirus pandemic as people a spend more time in socks and slippers in their homes. Without proper arch support, the tendon that connects the calf to the heel gets stretched.

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