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He'll likely need to use a walking boot for a few weeks, according to his doctor.

By Korin Miller
November 30, 2020
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President-elect Joe Biden is on the mend after suffering hairline fractures in his foot while playing with his dog.

Biden was spotted by reporters in the transition pool leaving the office of an orthopedist in Newark, Delaware, on Sunday. His doctor, Kevin O'Connor, later released a statement on the 78-year-old's condition.

"Initial x-rays did not show any obvious fracture, but his clinical exam warranted more detailed imaging," O'Connor said in the statement, per CNN. But a follow-up CT scan found "hairline (small) fractures" in the "mid-foot" area," O'Connor said. "It is anticipated that he will likely require a walking boot for several weeks," he added.

According to The Hill, Biden slipped and twisted his ankle on Saturday while he was playing with his German shepherd, Major. (Biden has another German shepherd, named Champ.)

Biden hasn't commented publicly on his injury, but a pool report from Sunday evening said the president-elect waved at reporters and flashed a thumbs up after leaving his doctor's office.

While you're probably familiar with what it means to break a bone, you might be a little fuzzy on fractures—including hairline fractures. Here's what you need to know.

So what is a hairline fracture?

A fracture, hairline or otherwise, is actually a break in a bone, Kenneth Jung, MD, foot and ankle surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, tells Health. "A hairline fracture is a common term for a crack in the bone," he explains. "The bone is still maintaining its shape, but there's a crack in it."

There are plenty of things that can cause a fracture, including car accidents, falls, sports injuries, osteoporosis, and overuse, according to Medline Plus says.

Hairline fractures can be so small that it's "common not to see them on X-ray," Dr. Jung says. Instead, a hairline fracture may be picked up when the bone starts healing or on a CT scan, which creates a 3D image of the area. "They look like a hair-thin break in the bone," in imaging, Lewis Nelson, MD, chair of the Department of Emergency Medicine at Rutgers New Jersey Medical School, tells Health.

Also worth noting: Some, but not all, hairline fractures can be stress fractures. "Most stress fractures are hairline, but the mechanism is more due to overuse—like running—than an acute trauma," Dr. Nelson says.

Are hairline fractures painful?

They don't exactly feel great, but Dr. Nelson says it could be worse. "Because the fracture fragments are not free-moving, they tend to hurt much less than displaced fractures," he says.

Still, "they can be painful," Dr. Jung says, comparing the feeling to having a sprain. Hairline fractures in the foot usually ache, Dr. Nelson says, adding that "pressure from walking can hurt."

In general, a person with a hairline fracture may have swelling, bruising, and difficulty putting weight on the area, Dr. Jung says. "Over the course of a few weeks, a patient will go from having sharp pain in the area to it feeling more like a bruise," Dr. Jung says. "The first two to four weeks are the worst."

How is a hairline fracture treated, and what is recovery like?

It depends. In most cases, a patient is given "comfort care," Dr. Nelson says, meaning they're urged to rest up and asked to wear a boot or cast to avoid injuring their foot even more. Crutches may also be used if someone is having pain when they walk, Dr. Jung says.

They may be given medication to help with the pain, but it's usually only an OTC pain reliever like acetaminophen, Dr. Nelson says.

If a patient is given a boot or cast, they'll usually wear it for six to eight weeks, Dr. Jung says. Once it comes off, the patient may have some joint stiffness and weakness. "Physical therapy can help get the rehabilitation process going," Dr. Jung says.

But, after that, a patient—and their bone—is usually good as new.

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