Introduction
The 58-year-old patient of white descent has a history of diabetes mellitus type II and hypertension with the subsequent therapy of metformin and hydrochlorothiazide. The patient is also classified as obese on account of a greater than ordinary body mass index (BMI) over 25. Therefore, the patient has significant risk factors for cardiometabolic multimorbidities on a history of advancing age and obesity (Kivimäki et al., 2017). The patient developed fever, chills, pain, swelling of the right great toe, the inability of his foot to carry weight, and pain on assessment of the right metatarsophalangeal joint, consistent with a fracture of the right great toe. For this reason, it is imperative to accurately describe the musculoskeletal and neurological pathophysiologic process involved in the presenting symptoms.
Neurological and Musculoskeletal Pathophysiology
The patient’s presenting symptoms are consistent with a big toe fracture. The patient’s underlying disorder of obesity would have contributed to the development of osteoporosis (Roy et al., 2016). The manifestation of obesity presents as the expression of interleukin 6 (IL-6), leptin, adiponectin, interleukin 10 (IL-10), tumor necrotic factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), macrophage colony-stimulating factor (M-CSF), Growth hormone (GH), parathyroid hormone (PTH), angiotensin II, 5-hydroxy-tryptamine (5HT), and myostatin that modulate the communication pathways to muscle and bones. The upregulated or downregulated chemical messengers TNF-alpha, IL-6, and leptins have negative modulation to osteoblasts, osteoclasts, and myocytes, contributing to osteoporosis and muscle atrophy. Osteoporosis leads to bone fragility due to decreased bone mineralization secondary to calcium and phosphate deficiency. Moreover, the patient has been on hydrochlorothiazide therapy for hypertension with the potential of causing hypophosphatemia leading to reduced bone mineralization (Roy et al., 2016). Therefore, the increased weight from obesity and osteoporosis leads to a stress fracture on the patient’s foot, manifesting as pain and swelling of the right great toe.
Inflammation is the product of the bone fracture manifesting as fever, chills, swelling, and pain to prevent further tissue damage. Acute inflammation begins with vasodilation in response to tissue injury leading to increased vascular permeability that allows the entry of inflammatory mediators (McCance et al., 2019). Subsequently, the increased vascular permeability leads to tissue edema manifested as swelling of the right great toe. The circulatory system, inflammatory cells, and injured tissues release chemical mediators that include vasoactive amines such as histamine for vasodilation, peptides such as bradykinin, eicosanoids from cell membrane phospholipids such as prostaglandins, cytokines such as interleukins and TNF, and acute-phase proteins such as C-Reactive proteins.
Consequently, the inflammatory mediators that include interleukin-1, TNF, and prostaglandins travel to the hypothalamus to reset the brain’s thermostat. The patient has fever and chills due to the thermostat reset in the brain’s hypothalamus. Additionally, the inflammatory process leads to an elevated Erythrocyte sedimentation rate of 33mm/hr and C-reactive protein of 24mg/L. Therefore, the obesity in the patient cascaded to osteoporosis and the ensuing inflammation from the stress fracture of the right foot.
Racial/Ethnic Variables in Physiologic Functioning
Several factors have an impact on the variations of physiological functioning among patients. Race or ethnic characteristics constitute part of the factors affecting physiological functioning. For instance, Cheung et al. (2017) established that the prevalence of obesity in African adolescents was 3.1% higher than in their Hispanic counterparts at 2.7%. However, the prevalence rate of hypertension was more significant among Hispanic adolescents at 3.1% compared to their African-American, White, or Asian counterparts at 2.7%, 2.6%, and 1.7%, respectively (Cheung et al., 2017). Moreover, Cheung et al. (2017) established that White adolescents with obesity were more likely to have sustained hypertension than African-American adolescents. For this reason, the findings indicate that the rate of adipose tissue metabolism and the subsequent complications of blood pressure disorder is ethnic/race dependent.
Conclusion
Advancing age with lifestyle habits such as sedentary living, and substance use contribute to a myriad of health challenges among the global population. Cardiovascular and metabolic disorders such as diabetes mellitus, hypertension, coronary heart diseases, congestive heart, obesity, and stroke constitute a significant proportion of the disorders associated with lifestyle characteristics. Moreover, ensuing obesity and osteoporosis has been linked to increased incidence of stress fractures.
References
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