Paget's Disease
Paget’s disease is named after James Paget, the doctor who first described the disease. It affects bones, mostly of the spine, thigh, shin or pelvis. This disease affects the process of breaking down and rebuilding of bones. Since new bones are built at a faster rate, there is likelihood of fractures and deformities. Consequently there is destruction of bone since the new bone that is formed is weak and porous. As a result, these bones are likely to bend easily and break. Paget's disease also leads to additional blood vessels (hypervascularity in the affected area. This condition affecting the bones is more likely to affect men and people over 40. Paget's disease is also known as osteitis deformans. Over time, Paget's disease can lead to osteoarthritis, kidney stones and heart disease. In rare cases, severe Paget's disease has been associated with heart failure or cancer.
The symptoms of Paget's Disease include pain and deep ache in the affected bones. The patient is likely to experience bone deformity or fracture in the affected area. There may be damage to the cartilage lining of the joints near the affected ones leading to osteoarthritis. Persons suffering from Paget's disease may suffer pain from nerve compression due to the pressure from bones. A person suffering from Paget's disease is likely to suffer elevated alkaline phosphate levels in the blood. There might be bone abnormalities such as enlargement, reabsorption and bowing.
Bone scans aid diagnosis of Paget's disease. Bone scintiscan can help detect the bones that have been affected. X-rays and blood test to check blood serum alkaline phosphatase can help in the diagnosis of Paget's disease. Treatment for Paget's disease is based on the extent of the disease, location of the affected bones and the medical history of the patient. Physical therapy and medication to inhibit abnormal bone reabsorption are prescribed. Bisphosphonates can reduce the activity of Paget's disease and are often prescribed for a period of 2 - 6 months. NSAIDs are given to alleviate pain and reduce inflammation. Surgery to realign affected bones or joint replacement are resorted to in cases where the joints are severely damaged or deformed.
Bone density test
Special x-rays are used to determine how many grams of bone mineral content (calcium and other bone minerals) is filled into a section of the bone. Bones with high mineral content indicate very dense bones thus indicating the bones are strong and have fewer chances of breakage. Bone density tests are recommended by doctors to check for osteoporosis. Bone density tests are done either by central or peripheral devices. Central devices are huge machines on which the patient can lie down. Such devices are mainly used to check the lumbar vertebrae (lower region of the spine), the narrow neck of the femur bone adjoining the hip and the bones of the wrist and the forearm.
Dual energy X-ray absorptiometry (DXA): This test produces exact results and is the most preferred choice to diagnose osteoporosis. The patient will be asked to lie down on a padded platform as an imager (an apparatus like a mechanical arm) passes above the body. The required information is captured by the device and the test is completed within 20 minutes. The amount of radiation exposure in this test is equal to one-tenth of a chest x-ray radiation. DXA scan can detect even a 1% change in the bone, that which can not be achieved through an ordinary x-ray.
Quantitative CT scan: The bone density (especially spine) is measured with the help of a computerized tomography (CT) scanner along with computer software. The scan produces a three-dimensional picture which also relates to the aging consequences of the bone and diseases other than osteoporosis. The patient is made to lie down on a movable table that is directed into a big tube-like area where images are pictured. The test is completed within 20 minutes and the radiation exposure is slightly more when compared to the DXA scan.
Peripheral devices are moveable machines that measure the bone density on the periphery of the skeleton. e.g. finger, wrist or heel.
They are smaller machines when compared to the central devices and can be found in pharmacies and have their own restrictions. These machines are used to check for the bone density in the heel, or wrist or fingers.
Metatarsal fracture
A fracture is called a metatarsal fracture when one of the long thin bones of the foot is fractured. It is also known as broken foot, and can be classified as Jones fracture, stress fracture of the foot, Lisfranc fracture dislocation, marcher's fracture, tennis fracture and dancer's fracture. Human foot has five metatarsal bones. Depending on the extent of injury and displacement, metatarsal fractures can be classified as minor or severe injuries. When this fracture occurs in an area of the foot where there is poor blood flow, the healing is more difficult. Jones Fracture is of this type and requires surgery to position the bones.
Twisting and dropping a heavy object on the foot are the two major causes for most of the metatarsal fractures. Direct impact of the falling object will result in a metatarsal fracture. Since the symptoms of this type of fracture may be similar to an ankle sprain, a metatarsal fracture may be missed at times. Though X-rays will help to confirm the fracture, a
CT scan or MRI is needed only when there are other injuries.
Keeping the injured foot at an elevated position will help to reduce the pain. One can use crutches to avoid pressure on the foot. Stiff soled shoe or a walking cast can be used as part of the treatment. A non-weight bearing cast for several weeks is prescribed for more severe fractures.If a metatarsal fracture has occurred in an area of the foot that has poor blood supply or if the bones are very much out of place, surgery is recommended. Maintaining good balance, good coordination and strength of the foot are some tips one should remember to avoid metatarsal fractures.
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