What Is A Stress Fracture?

What Is A Stress Fracture?

How Can You Tell If You Have A Stress Fracture In Your Foot?

Stress fractures are small, often microscopic breaks that can occur in the bones of the foot. Typically, these types of fractures develop without a specific traumatic incident. Instead, stress fractures form secondary to repetitive stress and overloading of the weight bearing bones of the foot.

These patients will initially present with a slow onset of discomfort, and report that their pain continues over the following days or weeks.

Risk factors such as a medical history of osteoporosis, vitamin D or calcium deficiency, and a previous stress fracture can place a patient at an increased risk of developing this pathology. However, stress fractures as a whole are viewed as overuse injuries.

First year military cadets are one of the most common demographics to develop stress fractures as they have a sudden increase in physical activity in the presence of repetitive activities., such as marching, running, etc. In this article we will discuss where stress fractures typically occur, signs and symptoms of a stress fracture, how a stress fracture is diagnosed, and what Cutting Edge Foot and Ankle can do to keep you on your feet!

Where Do Stress Fractures Normally Happen?

Although a stress fracture can occur in almost any bone in the foot or ankle, the most common place to be affected are the second and third metatarsals. The metatarsal bones undergo repeated strain during a typical gait cycle. When the foot pushes off the ground, the metatarsals will undergo the full extent of your body weight, and over time, the stress reaction will lead to a potential fractured bone.

Other bones that are commonly affected include the navicular, and the calcaneus (heel bone). High impact sports that include large degrees of running, jumping, and repetitive force can result in these overuse injuries. If your physical exam is consistent with a stress fracture, or if there is there is concern in any of the weight bearing bones, an imaging test may be used to assist in your diagnosis.


What Are The Signs And Symptoms Of A Stress Fracture?

The most frequent initial signs of stress fractures include pinpoint pain, swelling, tenderness, bruising, weakness, and difficulty with ambulation. Patients will demonstrate increased pain unilaterally with most weight bearing activities on the affected foot or ankle.

How To Diagnose A Stress Fracture

The first step in diagnosing a stress fracture will require a complete patient history, followed by a comprehensive physical examination. At this point, if your physician suspects a possible stress fracture, they will likely proceed with an X-ray of the injured foot.

In the case of a stress fracture, the bones often do not break completely, and the fracture site may not be clearly seen. In fact, a stress fracture may take up to 10-14 days after the onset of symptoms before it can be appreciated on imaging tests.

If an X-ray is inconclusive, some physicians may elect to utilize either a bone scan, or magnetic resonance imaging (MRI) to diagnose a stress fracture. MRI is considered to be significantly more sensitive for the diagnosis of a stress fracture compared to other imaging modalities, but it can be much more costly.

A bone scan is also more sensitive than an Xray but is largely inferior to an MRI. However, a bone scan is less expensive than MRI and can be a valuable tool in patients who are contraindicated for MRI use secondary to a pacemaker, etc.

How Long Does It Take For A Stress Fracture To Heal?

Most stress fractures of the foot and ankle will resolve in approximately six to eight weeks with appropriate immobilization in a walking boot. However, if there is a delay from when the initial injury occurs, to when a stress fracture is correctly treated, the overall recovery process can be lengthened considerably.

If surgery is indicated secondary to displacement of the fragments or non-union of the fracture, the timeline would once again be started at the date of surgery.

How To Prevent Stress Fractures

The best strategies for preventing a stress fracture are rooted in understanding the etiology of how a stress fracture first develops. From a biomechanical standpoint, a patient may be at heightened risk for a stress fracture because of their excessively high arches, and tight calf muscle complex.

This excessively tight calf complex combined with their foot structure, will result in increased forefoot pressure and lead to increased demand on the metatarsal bones. Therefore, an effective treatment strategy for this particular patient is rooted in an aggressive stretching regimen combined with arch supports in supportive shoe gear that will reduce early muscle fatigue and the excessive demand on these high-risk structures.

Often, stress fractures develop secondary to inadequate nutrition. If a patient has a history of eating disorders, or other metabolic medical conditions, it may result in weakened bones with decreased bone density.

Supplementation, or even meeting with a qualified nutritionist can be essential in providing your bone tissue with the required nutrients to withstand all types of physical activity and repetitive forces.

Many stress fractures will develop in athletes who play high impact sports or are starting a new exercise regimen. Therefore, it is recommended to cross-train, or maintain diversity with exercise to ensure that less stress is occurring at high risk areas.

Avoiding use of improper equipment, training on uneven surfaces, and utilizing poor technique are essential in avoiding fractures of the foot. If you are new to exercise, consider investing in a personal trainer to help you develop good techniques that will ultimately reduce the risk of injury.

How To Treat a Stress Fracture? Will I Need Surgery?

It is relatively rare that a stress fracture will require surgical intervention. Typically, a stress fracture can be treated with immobilization in a walking boot to reduce stress on the affected bone. Over time, immobilization with protective footwear, in the presence of a healthy diet can promote healing of the injured bone.

If the bones cannot heal properly in the expected timeline, or if there is a loss of appropriate anatomical normal alignment, surgery with internal fixation may be indicated. Failure to address fractures of the foot will often result in further injury or a delay in the overall healing process. As the bones continue to heal, a callus should form between the two fractured ends demonstrating resolution of the fracture.

For inflammatory control and to relieve pain, your physician may recommend use of counter pain medication, and the rice method. The RICE method stands for rest, ice, compress, and elevate. Keeping your swelling well-controlled adjacent to the affected bone can be critical in obtaining pain relief.

Once the fracture has fully resolved, patients will typically need to transition into protective footwear that includes a stiff soled shoe to prevent recurrence of the stress fracture. After a full recovery has been met, some patients may require physical therapy, however this is rarely indicated.

What Services Does Cutting Edge Foot And Ankle Clinic Provide?

Are you worried that you might be developing a stress reaction in your foot or ankle? Have you recently started a new exercise program and are having difficulty putting weight down on your foot?

If you are having any of these or other symptoms, please book an appointment with us online, or give us a call at 615-866-9639. Between our 5 locations, our providers will develop a comprehensive treatment plan that that is uniquely designed to fit your needs and lifestyle. Cutting Edge Foot and Ankle is available for same day appointments!