You may have read in the news that tennis player Victoria Azarenka recently dropped out of the Dubai Championships due to an injury in her right foot, attributed to a bone bruise. If so, you may be thinking that a bruise doesn’t sound like enough of an injury to make someone drop out of a championship!
TSAOG’s Dr. Marvin Brown tells me why it should.
What is a bone bruise?
The term bone bruise is a misnomer and makes the injury seem less serious than it is. A so-called bone bruise is actually a fracturing of the inner layer of bone.
Bones are composed of 2 different types of bony tissue, the compact (cortical) bone and the cancellous (spongy) bone.
- The compact bone is the outer layer of bone and is highly organized, solid, and extremely strong. When you injure this layer of the bone, it is referred to as a stress reaction or an occult fracture.
- The cancellous bone is the innermost layer of bone. Unlike the outer layer of bone, it is not arranged in concentric layers, but in plates (called trabeculae) which form an irregular meshwork that is neither as organized nor as strong as the outer bone. An injury to this area of the bone represents very small fractures to the trabeculae in the meshwork of the bone and may be referred to as a bone bruise.
How does a bone bruise happen?
This type of injury can be a result of repetitive trauma or stress where the inside of the bone is damaged, resulting in bleeding into the damaged area. It can also happen as a result of acute trauma, where forces are not strong enough to fracture the outer bone, but are strong enough to fracture the inner layer of bone.
How do you diagnose a bone bruise?
We normally use a combination of patient history, physical examination and MRI to diagnose a fracture to the inner layer of bone. However, injuries to the inner bone will not be evident on xray or CT scan.
What is the normal treatment for a bone bruise?
I usually recommend bracing or other immobilization of the area to allow it time to heal and to protect it from additional injury that can be caused by bearing weight on the injured area. Activities also need to be restricted during this healing period, particularly sports play, which can result in additional acute trauma, causing greater injury and/or prolonging the healing time.
How long do you normally expect recovery to take?
Recovery can take several months because the inner layer of bone takes longer to heal than the outer bone.
Dr. Marvin R. Brown is a board certified orthopaedic surgeon who has completed additional fellowship training in conditions of the foot, ankle and lower leg. He treats patients aged 1 year and up for any musculoskeletal issue below the knee. His special interests include total ankle replacement and Achilles tendon reconstruction. To schedule an appointment with Dr. Brown, please call 210.281.9595.