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What is a Cuneiform and How Will They Impact Joe Biden?

We know that President-Elect Joe Biden had a mishap while playing with his dog over the holiday weekend, leading to a twist of his ankle and hairline fractures of 2 bones in his foot. The lateral and intermediate cuneiforms that were fractured are pictured here:

There is much discussion of President-Elect Biden’s advanced age, and two possible age-related risk factors may have contributed to his likelihood of experiencing this injury.

Low Bone Mineral Density

For men, bone mineral density is at its highest between the ages of 20-29. (Sezer, 2015) While men do not experience the rapid drop off in bone mineral density that women do following menopause, bone density does decline as men age. Osteoporosis in men is an underdiagnosed condition and increases risk for fractures.

Limited Ankle Mobility

Several studies have demonstrated loss of ankle range of motion in older adults, which is also considered to be a significant risk factor for falls. (Menz, 2015) When the ankle cannot bend through its normal range (imagine pulling your toes up towards your nose) because of calf muscle tightness or joint stiffness, other motions must make up the difference during an unanticipated movement. This potential for increased stress to the internal foot bones and foot and ankle ligaments could contribute to sustaining a fracture under the right conditions.

Rehabilitation Implications

President-Elect Biden is anticipated to have full recovery with a few weeks of immobilization in a walking boot, but immobilization itself can also be problematic. Even just one week of ankle immobilization has a detrimental effect on calf strength and balance. (Caplan, 2013) Longer periods of immobilization may require consultation with a physical therapist to restore range of motion, strength, balance and gait pattern to ensure a full recovery and addressing any risk factors for future injuries.

References:

Sezer A, Altan L, Ozdemir O. Multiple Comparison of Age Groups in Bone Mineral Density Under Heteroscedasticity. Biomed Res Int. 2015; 2015:426847.

Menz HB. Biomechanics of the Aging Foot and Ankle: A Mini-Review. Gerontology. 2015;61:381-388.

Caplan N, Forbes A, Sarkhell R., et al. Effects of 1 Week of Unilateral Ankle Immobilization on Plantar-Flexor Strength, Balance, and Walking Speed: A Pilot Study in Asymptomatic Volunteers. Journal of Sport Rehabiliation. 2013;24:156-162.

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