Bone mineral density of the tarsals and metatarsals with reloading.
OBJECTIVE
Bone mineral density (BMD) decreases rapidly with prolonged non-weight bearing. Maximizing the BMD response to reloading activities after NWB is critical to minimizing fracture risk.


METHODS
for measuring individual tarsal and metatarsal BMD have not been available. This case report describes tarsal and metatarsal BMD with a reloading program, as revealed by quantitative computed tomography (QCT).


METHODS
A 24-year-old woman was non-weight bearing for 6 weeks after right talocrural arthroscopy. Tarsal and metatarsal BMD were measured with QCT 9 weeks (before reloading) and 32 weeks (after reloading) after surgery. A 26-week progressive reloading program was completed. Change scores were calculated for BMD before reloading and BMD after reloading for the total foot (average of all tarsals and metatarsals), tarsals, metatarsals, bones of the medial column (calcaneus, navicular, cuneiforms 1 and 2, and metatarsal 1), and bones of the lateral column (calcaneus, cuboid, cuneiform 3, and metatarsals 2-5). The percent differences in BMD between the involved side and the uninvolved side were calculated.


RESULTS
Before reloading, BMD of the involved total foot was 9% lower than that on the uninvolved side. After reloading, BMD increased 22% and 21% for the total foot, 16% and 14% for the tarsals, 29% and 30% for the metatarsals, 14% and 15% for the medial column bones, and 28% and 26% for the lateral column bones on the involved and uninvolved sides, respectively. After reloading, BMD of the involved total foot remained 8% lower than that on the uninvolved side.


CONCLUSIONS
The increase in BMD with reloading was not uniform across all pedal bones; the metatarsals showed a greater increase than the tarsals, and the lateral column bones showed a greater increase than the medial column bones.
Hastings
Mary Kent
MK
Program in Physical Therapy, School of Medicine, Washington University, 4444 Forest Park, Room 1101, Campus Box 8502, St Louis, MO 63108-2212, USA. hastingsmk@wustl.edu
Gelber
Judy
J
Commean
Paul K
PK
Prior
Fred
F
Sinacore
David R
DR
D000328:Adult; D000843:Ankle Joint; D001182:Arthroscopy; D015519:Bone Density; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000534:rehabilitation* / Q000601:surgery; D008682:Metatarsal Bones; D013639:Tarsal Bones; D016138:Walking / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology