Foot Stress Fracture

A stress fracture is a small crack in a bone. The most common areas for stress fractures are the metatarsals (particular 2 and 3) and thecalcaneus.

What Causes A Stress Fracture?

Stress fractures usually develop from overuse or repetitive trauma in impact sports such as running or basketball. Other patients with weakened bones (such as in osteoporosis) can also have stress fractures.

A stress fracture usually occurs when you increase: frequency, duration, or intensity of your high impact activity. The common term “too much too soon” applies here. If you are not properly conditioned, then doing too much can lead to fatigue and stress fracture.

This is why I always recommend that my running patients slowly transition from indoor treadmill running to outdoor running to avoid injury.

This leads straight into the importance of proper technique. Fatigue can alter the biomechanics of any movement resulting in injury or stress fracture. For example, plantar fasciitis often results in medial heel pain. Many runners will try to compensate by running on the outside of their foot. This can lead to excessively high foot pressures along the 5th metatarsal and a possible stress fracture.

Improper equipment, such as a worn out running shoe, can result in both abnormal foot pressures and improper technique. Women improperly transitioning into higher heeled shoes is another example.

A change in environment can also contribute to a stress fracture. An improper transition from indoor to outdoor running is again an example of environment increasing the risk of stress fracture.

Finally, bone insufficiency due to any number of causes (osteoporosis, metabolic issues, abnormal or absent menstrual periods). Weakened bone leads directly to stress fracture.

What Are The Symptoms Of A Stress Fracture?

Gradual development of pain, especially with weight-bearing. Pain is relieved by rest. Swelling can develop on the top of the foot or the outside of the ankle. Pain is noted to touch at the fracture site.

What Should I Do If I Think I Have A Stress Fracture?

The first thing you must do when you suspect that you have a stress fracture is STOP THE ACTIVITY and REST. Continued stress and impact onto the injured bone can result in complete fracture.

You should also ice and elevate the injured foot. I don’t usually recommend NSAIDs as they can slow bone healing. Report to a doctor for further treatment.

Evaluation

After a proper physical, the doctor will usually perform an X-ray when they suspect stress fracture. Stress fractures can be difficult to see on X-ray until they are already healing. If X-rays are inconclusive I usually order an MRI (bone scan also works).

How Do I Get Back To My Normal Activities After I’m Healed?

When I note that your fracture is healed and pain free, I SLOWLY return you to your typical activities. This is often the most difficult part of the treatment process as it requires the patient to hold back and only do as little as instructed. I also recommend varying your exercise activities to ensure that your foot doesn’t experience repetitive stress until the bone and foot have recovered their strength.

How Does A Doctor Treat A Stress Fracture Conservatively?

REST is still the key factor in healing a stress fracture. It usually takes 6 to 8 weeks to heal a stress fracture. During this time high impact activity is stopped: no running and no jumping activities. Usually I would recommend swimming or cycling for aerobic activity during this time depending on the degree and placement of the stress fracture.

Protective shoe gear: I recommend protective shoe gear to reduce stress on the foot, ankle, and leg. This can be as simple as a stiff-soled shoe or a removable short leg fracture boot.

Casts: Certain fractures (such as a fifth metatarsal fracture) can take longer to heal. In those cases, I like to eliminate all the external stress from the bone in order to optimize healing. Crutches are a must in these instances.

What if Conservative Treatment For My Stress Fracture Fails?

Surgical management is warranted in some cases. This usually involves “open reduction with internal fixation”. This surgery requires opening the foot to bring the bone back together and then holding it in place with metal surgical pin, screw, or plate. The patient is placed in a cast postoperatively for 4 to 6 weeks.