Edited by Hossein Pakzad MD
Watch Video: Introduction to Stress Fractures of the foot
Stress Fractures occur when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces, often leading to microscopic cracks in the bone, called “microfractures.” Normally, the body is able to sufficiently heal these microfractures, leading to a stronger bone able to accommodate these higher forces in the future. However, when the rate of loading on the foot is such that the body’s healing response cannot keep up, a stress reaction can develop. Eventually, if the forces continue, the bone structure can fail and a stress fracture will occur. An individual’s lack of sufficient biology to heal microfractures (i.e., low calcium, vitamin D, or thyroid hormone) can also contribute or lead to stress fractures.
Stress fractures occur in the same manner that you would break a paper clip – excessive wiggling back and force will lead to breakage. Stress fractures can occur in:
- Normal bone that is subject to extraordinarily excessive repetitive loading. An example of this would be a new army recruit going on a long march as part of basic training who, as a result of this dramatic increase in repetitive loading, develops a stress fracture (often called a “March” fracture).
- Weakened or brittle bone that is subject to seemingly normal repetitive forces. For example, a person with thin bone (ex. osteoporosis) who walks much more than they are used to.
Stress fractures do not occur in random locations. They occur in certain bones, and locations within those bones, that are absorbing excessive repetitive force. Some of these bones have distinct areas with diminished blood supply which makes them prone to have less potential for healing. Each person’s foot absorbs force in a slightly different manner, which is dictated by that person’s foot shape, alignment, foot stiffness, and gait pattern. Common sites of stress fractures in the foot include:
- 2nd or 3rd Metatarsal Neck Region
- Base of 5th Metatarsal (Jones Fracture)
- Sesamoids of the Great Toe
Diagnosis of a stress fracture requires a high degree of suspicion as the fracture often does not show up in the first two weeks on the initial x-ray. Patients will usually report localized aching pain in the effected area. They will give a history of some increase in their normal activity level (ex. went for a long hike this weekend). They usually do not report a specific injury when the pain began. They may have a history of a condition that predisposes them to weaker bones such as: Osteoporosis (weak thin bone); Amenorrhea (loss of normal menstrual cycle); or a history of smoking.
X-rays may initially be negative, as it often takes 10 days or more for a callus (new bone) to form and be visualized on x-rays. Bone scans and MRIs are more likely to be positive in stress fractures. It is possible, and in fact common, to see fluid or “edema” in bones on an MRI without having an obvious stress fracture. This represents a “stress reaction” and is equivalent to microscopic bone fracturing without a complete stress fracture. The fracture, if present, is usually visible on an MRI. If there is a concern, a CT scan can usually confirm the diagnosis of stress fracture, as well as clearly define the location and size of the fracture.
Most stress fractures do not require surgery. Treatment generally involves:
- Resting the affected area until the bone adequately heals, often 6-8 weeks or more. This can be accomplished with crutches and a CAM walker boot.
- Avoiding any activities that caused the injury or exacerbate the symptoms.
- Correcting any risk factor that may predispose to further stress fractures, including training issues, footwear, and nutritional or hormonal deficiencies. Certain stress fractures may require surgery in order to aid in healing or prevent non-healing (i.e., non-union) or refracture. These “high risk” stress fractures include the Jones fracture, a displaced navicular stress fracture, and other stress fractures that may not heal adequately with non-surgical treatment. The decision for surgery should be made by an orthopaedic surgeon with experience treating these types of injuries.
Edited on October 24, 2017
Previously Edited by Kenneth Hunt, MD


(Guest post by Yuto Katoh)
The frontier letter article by Liu (2016), published in Earth, Planets and Space, reported a potential connection between the El-Nino Southern Oscillation (ENSO) and the upper atmosphere. Using a long dataset spanning 46 years of the air mass density at 400 km height, the analysis revealed two oscillating modes of the upper atmosphere. One mode has a period of about 2 years, and the other of ~5 years. The 5-year mode is found to highly correlated with ENSO activity in the troposphere (Figure 1, upper panel) while the 2-year mode shows correlation with the stratospheric QBO (Figure 1, bottom panel) likely modulated by the solar cycle.
This finding has important implications for space weather research and operations. Space weather refers to perturbations of the upper atmosphere, which is a critical region for modern space technology like wireless communication, global navigation and positioning, also orbit control of low-earth-orbiting satellites and their reentries. ENSO’s tele-connection with the upper atmosphere, hence space weather, tells us that in addition to social and economic effects we hear from the media, tropospheric climate change can also significantly influence the high-tech systems that strongly depend on space operations.


Lysosomes are one type of recycling unit in the cell, responsible for breaking down damaged cellular components and some unwanted proteins. One of the causes of aging is that in long-lived cells types of metabolic waste that cannot be broken down accumulate in lysosomes. These compounds are collectively called lipofuscin, and their presence in large amounts renders lysosomes bloated and inefficient. Cellular housekeeping as a whole then deteriorates until cells die or fall into dysfunctional states that harm tissue function. Everyone has this to look forward to. There is much less work taking place on a solution to this issue than on the analogous problem of lyososmal storage diseases, however, a collection of rare genetic disorders in which the lysosome lacks some of the tools it needs to break down ordinary, common structures and unwanted molecules. These compounds build up inside the cell and it eventually dies. If you follow the field of aging research you will see this over and and again: the harms that happen to everyone at the end of life are largely ignored, but there is much more interest in tackling similar problems that happen to just a few people in younger years.
Researchers here are looking at lysosomal exocytosis, which is a fancy term for the process in which a lysosome docks at the interior of the cell surface and then throws its cargo of garbage outside the cell. The degree to which this normally happens can be increased greatly, and early indications are that this is a potentially beneficial approach to treating lysosomal storage diseases. Will this be useful in the lysosomal issues that accompany aging, however? The type of garbage at issue is totally different, and it may well be that this would just swap the one problem for another. We have no idea what large amounts of lipofuscin between long-lived cells in nerve tissue will do over the long-term, though this is certainly something that could be investigated. Overall I'd prefer the SENS approach of infusing the body with enzymes that can safely break down lipofuscin constituents, but all of these strategies are at least worth investigation.
Lysosomes are acidic compartments in mammalian cells that are primarily responsible for the breakdown of endocytic and autophagic substrates such as membranes, proteins, and lipids into their basic building blocks. Lysosomal storage diseases (LSDs) are a group of metabolic disorders caused by genetic mutations in lysosomal hydrolases required for catabolic degradation, mutations in lysosomal membrane proteins important for catabolite export or membrane trafficking, or mutations in nonlysosomal proteins indirectly affecting these lysosomal functions.
A hallmark feature of LSDs is the primary and secondary excessive accumulation of undigested lipids in the lysosome, which causes lysosomal dysfunction and cell death, and subsequently pathological symptoms in various tissues and organs. There are more than 60 types of LSDs, but an effective therapeutic strategy is still lacking for most of them. Several recent in vitro and in vivo studies suggest that induction of lysosomal exocytosis could effectively reduce the accumulation of the storage materials. Meanwhile, the molecular machinery and regulatory mechanisms for lysosomal exocytosis are beginning to be revealed. In this paper, we first discuss these recent developments with the focus on the functional interactions between lipid storage and lysosomal exocytosis. We then discuss whether lysosomal exocytosis can be manipulated to correct lysosomal and cellular dysfunction caused by excessive lipid storage, providing a potentially general therapeutic approach for LSDs.


Food contact materials (FCMs) are challenging to identify because of their complicated matrices and restricted commercial standards. Using tools based on machine-learning algorithms can help identify these substances.
Recent research published in the Journal of Agricultural and Food Chemistry demonstrates the usage of in silico collision cross-section modeling (CSS) and retention time (RT) techniques to detect inert migrates from food contact materials using liquid chromatography-ion mass spectrometry. Investigating the chemical migration from polyamide (PA) spatulas helps determine this approach's suitability.
Detrimental Effects of Food Contact Chemicals (FCCs)
During processing, transportation, preservation and delivery, food and drinks can come into contact with various materials.
Chemicals in food contact materials can migrate into food and cause health issues for consumers.
In some instances, food-contact materials can also include unwanted chemicals (FCCs) such as the degradation products of additives, the polymer itself, industrial solvents, or the by-products of chemical reactions.
Paper, wood, glassware, metal, plastic, and biomaterials are all FCMs.
Plastic polymers most frequently come into contact with food. Additives are employed in plastics manufacturing to improve the finished product's performance. Plasticizers, inhibitors, binders, and lubricants are some of the most often used additives. These additives can migrate into food since they are not usually chemically bonded to the polymers.
It has been reported that the food contamination caused by chemical materials from FCMs could be 100 times greater than that from synthetic pesticides and industrial pollutants.
Challenges Associated with Identification of FCCs
Accurate detection of FCCs from FCMs is difficult due to the complexity of the plastic matrix, unknown contents, and restricted standards. The elemental composition of detected substances can be estimated from the primary ion and isotopic dispersion using high-resolution mass spectrometry (HRMS), incorporating time-of-flight (TOF).
Molecules with a specific chemical formula in ChemSpider or PubChem reveal several probable structures. Analysts with knowledge in MS spectrum interpretation are needed for elimination of implausible entries and to reduce false positives.
Potential of Ion Mobility Mass Spectrometry for FCCs Detection
In recent years, ion mobility spectroscopy has been extensively employed for the controlled and uncontrolled screening of complex samples.
Collision cross-section derived from ion mobility mass spectrometry is a stable characteristic associated with particle size, morphology, and potential.
Collision cross-section measurements combine retention time (RT), precise mass, atomic pattern, and fragmented ions for chemical identification.
Limitation of Collision Cross-Section Based Ion Mobility Mass Spectrometry
A constraint in detecting FCCs emerging from FCMs is that many suspected compounds are not commercially accessible. Consequently, accurate and definite identification cannot be validated by matching the collision cross-section values of unknowns to those of standard values.
Development of Collision Cross-section Prediction Models Using Machine Learning Approaches
To improve FCC detection by ion mobility mass spectrometry's, researchers have developed machine learning-based collision cross-section prediction models. Based on liquid chromatography, ion mobility mass spectrometry and collision cross-section (CCS) prediction tools, Song et al. have proposed a method to detect non-volatile chemicals in FCMs.
The Food Contact Chemicals Database (FCCdb) and the Chemicals linked with Plastic Packaging Database (CPPdb) are two databases with information on FCMs. The predicted models designed by researchers were employed to forecast the RT and CCS values of the chemicals in the CPPdb and FCCdb. The structural elucidation method included the two databases as screening libraries.
By analyzing the migration of chemicals from PA spatulas, the efficacy of these two databases in detecting FCCs were assessed.
After using the RT and CCS prediction filters, the number of relevant compounds was decreased by around 75% and 29%, respectively. The PA spatulas included 95 different chemicals, 54 verified using reference standards.
According to researchers, the detection of chemicals in FCMs can be aided by creating a database comprising projected RT and CCS values of compounds associated to FCMs.
Predicted RT and CCS values can be added to the identification procedure to increase identification confidence, although they do not conclusively show the compound's existence.
By screening against chemicals in two public databases (CPPdb and FCCdb) with improved predicted RT and CCS values based on machine learning, different compounds present in FCMs can be discovered.
Predicted RT and CCS values can be employed efficiently to drastically reduce false positives and enhance the accuracy of identiﬁcation. Adding more measured values to the appropriate training sets increases RT and CCS forecasts' accuracy.
Song, X.-C., Canellas, E., Dreolin, N., Goshawk, J., & Nerin, C. (2022). Identification of Nonvolatile Migrates from Food Contact Materials Using Ion Mobility–High-Resolution Mass Spectrometry and in Silico Prediction Tools. Journal of Agricultural and Food Chemistry. https://pubs.acs.org/doi/10.1021/acs.jafc.2c03615


The severe crimes of fascists still terrify people all over the world. And among those who gave inhuman orders were women, no matter how scary it is. Let’s look at top-10 cruel women of the Third Reich.
This representative of German women was the warden of Nazi death camps called Ravensbruck, Auschwitz as well as Bergen-Belsen. She had such nicknames as “Blonde Devil”, “The angel of death” and “Beautiful monster”.
She used emotional and physical methods to torture against prisoners. She beat women to death and enjoyed the random shooting of detainees. Irma starved her dogs in order to set them against victims afterwards. She personally selected hundreds of people for sending them to gas chambers. In the post-war press they discussed her probable sexual deviancy with SS guards.
In April 1945 Irma was captured by the English. She was found guilty and sentenced to be hanged by the British military tribunal. On the last night before the execution she sang songs with one of blonde women who were her colleague named Elizabeth Volkenrath. When a noose was put around her neck she remained calm. Her last word to an English executioner was “Hurry up!”
This member of NSDAP was Karl Koch’s wife – he was the commandant of Buchenwald and Majdanek concentration camps during WW2. She got the nickname “Buchenwald Witch” for the severe torture of the camp’s prisoners. Ilse was also accused of making souvenirs out of human skin.
In June 1945 she was arrested by the American troops and sentenced to life imprisonment. Then she was released by an American commandant who believed that the charges against Ilse had been insufficiently substantiated.
It gave rise to protests from the public, therefore in 1951 Koch was arrested again and sentenced to life imprisonment by the German Court. In 1967 Ilse committed suicide by hanging herself in a Bavarian prison cell.
She was one of those German women who became the overseers of women’s concentration camps of the Third Reich. Luise started to work in Ravensbruck camp, then she was transferred to Majdanek. She also served in Malchow and Auschwitz.
Danz beat detainees and confiscated their winter clothes. In Malchow, where she held the position of a senior overseer, Luise starved prisoners giving them food once every three days. In April 1945 she killed a girl.
She was arrested in June 1945 and sentenced to life imprisonment. But in 1956 Danz was released for health reasons. When in 1996 she was again charged with murdering the child, doctors said that it would be very hard for one of ageing women to bear another imprisonment and the charges against her were dropped. They say she is still alive and lives in Germany.
Between 1940 and 1943 she, unlike many of Nazi women, Jenny-Walda worked as a fashion model and didn’t relate to warrior women. Then, Jenny started working for the Third Reich and became the warden of Stutthof camp. She was famous for the severe beating of female prisoners, some of them she beat to death.
She also participated in the compilation of a list of children and women who were supposed to be sent to gas chambers. Barkmann was cruel and wonderful, that’s why prisoners called her “Beautiful ghost”.
She was arrested in May 1945 and found guilty, after which Jenny was given the last word. She said: “Life is really great pleasure, but, as a rule, the pleasure doesn’t last long”.
Barkmann was hanged in public not far from Gdansk in 1946. Her body was burnt and her dust was washed away in the restroom of a house where she had been born.
Herta Gertrude Bothe
In 1942, she started to serve the Third Reich as the overseer of Ravensbruck camp. Then, Herta was transferred to Stutthof camp near the city of Gdansk. In it, she got the nickname “Stutthof sadist” because of cruel treatment of women-detainees.
Since January 1945 she was the warden of death march which began from central Poland and finished at Bergen-Belsen camp. After the liberation of the camp Herta was arrested.
On Belsen Trial she was sentenced to 10 years’ imprisonment. However, Herta was released in 1951 ahead of time. She died in March 2000 in Huntsville, the USA.
For the period 1942-1944 she held the position of the chief of Auschwitz-Birkenau female camps and directly responsible for the death of half a million female prisoners.
Auschwitz’s detainees called her a beast. Maria was one of few women who personally sent thousands of people to gas chambers.
There were cases where Mandel took some prisoners under her wings and when she got bored with them Maria included those prisoners in a list of people on a death row.
The idea of creating a camp orchestra also belonged to her. That orchestra met newly arrived prisoners with happy music at the gate of the camp. Mandel was a big fan of music and often came to musicians’ barracks in order to listen to them.
In August 1945 she was arrested by American troops. Then Maria was handed over to the Polish authorities upon request. She was sentenced to death by hanging by the court. The sentence was carried out in January 1948 in a Krakow prison.
She began her service at the Ravensbruck camp in October 1944 by becoming a senior warden. Due to her hard work she was transferred to Theresienstadt camp as the head of all camp’s overseers. According to prisoners, that beauty was cruel and ruthless to them.
Hildegard controlled more than twenty thousand Jewish women. She contributed to the deportation of more than 40000 women and children from Theresienstadt to Auschwitz and Bergen-Belsen where most of them were killed.
Neumann left the concentration camp in May 1945 and didn’t face criminal prosecution for the war crimes. The further fate of Hildegard Neumann is unknown.
Unlike many other German women who served in camps as wardens, Herta did other jobs. Being a doctor, Herta Oberheuser did cruel experiments on children in Auschwitz and Ravensbruck camps. She killed them with the help of the injections of barbiturates, removed their limbs and vital organs. Herta’s victims died in terrible agony fully conscious.
Moreover, she experimented with the infections of injuries inflicting cuts of children’s skin and rubbing dirt, glass and rust in it.
At the Nuremberg trial Herta was sentenced to 20 years’ imprisonment. Nevertheless, having stayed behind bars for 5 years, one of the cruelest Nazi women was released for good behavior and returned to medical practice. Only in 1958 when the survived victim of Herta’s terrible experiments identified her, the sadist’s medical career was over.
Alice Orlowski (ranks among women of the Third Reich who changed her attitude towards detainees)
For years Alice has been considered to be one of the Third Reich’s severest women-wardens. She knocked out prisoners’ eyes by lashes and, then, sent blind people to gas chambers. It was she who began to throw children to gas chambers over the heads of adults in order to increase the capacity of chambers.
Nevertheless, by the end of the war, her attitude towards prisoners strangely changed, and she began to sympathize with them – Alis brought them water and food and helped in any possible ways.
Nobody knows how sincere her “rebirth” was. We know one thing — after the war Alice served only 10 years on sentence and then lived a normal life. She died on the loose in 1976 at the age of 73.
Johanna was one of those Nazi women who oversaw Auschwitz camp. Johanna joined the SS as a civil servant because of need for money.
She worked in Lichtenburg as a worker in a kitchen (until May 1939). Since May 1939 Bormann served in Ravensbruck camp as a warden. Then she was transferred to Auschwitz-Birkenau.
Johanna was characterized by sadism. She constantly set her sheepdogs on prisoners. (That’s why she got the nickname “Lady with dogs”).
In January 1945 she was evacuated to Bergen-Belsen. In April 1945 she was among those Nazi women who were captured by the Allied Coalition Forces.
Johanna appeared before the court of the British military tribunal as an accused in the Bergen-Belsen workers proceedings. She was sentenced to death by hanging. The sentence was carried out in December 1945.


Most of us know women who have fought breast cancer - mothers, grandmothers, sisters, aunts, daughters, friends, neighbours... Perhaps you're even fighting the disease yourself.
It goes without saying that breast cancer is an epidemic. One in every eight woman will develop the disease, and close to 40,000 women die from it each year. According to science, common chemicals like Bisphenol-A, phthalates and parabens, which are found in food, cleaning products and personal care items, play a major role in breast cancer incidence by disrupting your hormones.
The good news is that it's easy to avoid your exposure to these three breast cancer-causing chemicals by simply reading labels and making smart choics when you're shopping. Here are some tips...
Three chemicals that cause breat cancer
#1: Bisphenol-A (BPA)
BPA is found pretty much everywhere, from canned foods to plastic water bottles. Studies have shown that it’s link to early puberty, a big risk factor for later-life breast cancer
, and that it can make healthy breast cells grow and survive like cancer cells. What’s more, some research suggests that BPA can even make breast cancer
drugs less effective!
To reduce your exposure of BPA, avoid buying canned foods, choose glass or stainless steel instead of plastic to store water and food and ensure that your children’s toys are BPA-free.
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The real key to healing cancer is to wipe out the stealth disease lurking behind it...
I admit I was downright shocked when I found out that cancer
isn't actually what kills most cancer
patients! And I've been a doctor for well over 20 years - so not much surprises me anymore.
Even more astounding - this monumental discovery goes back to the 1970s when former US Air Force Dr Joseph Gold uncovered the REAL killer, a condition that no one in the medical field was even talking about!
That's right - the real culprit behind 3 out of every 4 cancer
deaths isn't cancer at all. No! It's a syndrome you've probably never even heard of - called cachexia (pronounced "ka-kek-see-ah").
Most commonly used to make plastics pliable and soft, phthalates are a class of chemicals found in a number of products. They’re most commonly found in cosmetics, air fresheners, detergents and common cleaning products. You can avoid phthalates by opting for products that are labelled “phthalate-free” and using unscented products or those scented with natural essential oils instead of scented candles, air fresheners and household cleaners.
You’ll also want to stop buying vinyl products, which are usually softened with phthalates. Instead of a shower curtain made with PVC, choose one made with cloth or nylon. Your children’s toys should also always be PVC-free!
Found in most cosmetics, including deodorants and lotions, parabens are widely used as preservatives. Your skin quickly absorbs this chemical, which has been strongly associated with breast cancer
incidence. In fact, a particular study found parabens in a whopping 99% of breast tissue samples. Sixty percent of the samples contained at least five parabens!
Your best bet to eliminate parabens from your beauty routine is to only use products that are labelled “paraben-free”. You should also read product labels thoroughly and avoid ones that list ingredients that end with “paraben”, such as methylparaben.
This list is by no means exhaustive and there are, of course, many other chemicals associated with breast cancer incidence. There are also lots of other ways that you can cut your risk of breast cancer, but avoiding these three common carcinogenic chemicals is a very good starting point.