Stress Fractures

A side view of a foot with a hand holding the ankle. The ankle is highlighted red signifying pain

What is a stress fracture?

Stress fractures are tiny cracks in the bone (microfractures) that develop gradually overtime. Usually due to overuse or repetitive activity that restricts the bone from healing. They are most common in athletes or people who engage in activities or sports that heavily involve running or jumping e.g. soccer, basketball and track and field. 

Stress fractures and regular fractures are different injuries. As you may already know, regular (acute) fractures occur instantaneously and unexpectedly in a single incident, when a force is exerted against the bone that it can not withstand, causing the bone to break or crack. A regular fracture often occurs during traumatic incidents such as sporting injuries, bad falls or vehicle accidents. 

Stress fractures differ in the way that the onset is gradual and cannot be narrowed down to a single incident.  They often occur in the feet and lower limbs as these areas of the body bear the most stress during every day activities and exercise. 

Common locations of a stress fracture

  • Sesamoid bones 
    • This are 2 little bones under the big toe joint 
  • Metatarsal head and shaft and commonly the 2nd 
    • This is under the ball of your foot

Uncommon sites that are very serious in nature 

This is due to these sites being high risk and of non - healing/union;

  • Navicular 
    • This is the bone on the top of your foot, above the arch.
  • 5th Metatarsal base and shaft 
    • This is the long thin bone on the outside border of your foot.
  • Calcaneus
    • This is your heel bone.




Causes

The common causes of stress fracture's include:

  • Excessive and abnormal stress from weight bearing activities e.g. running, jumping or dancing.
  • Training or landing on hard surfaces from a height.
  • Suddenly increasing the time and intensity of an exercise program.
  • Weak muscles in the lower legs and feet.
  • Poor range of motion and mobility in joints, which increases the loading on the bones.
  • People suffering from osteoporosis and other conditions that reduce bone density.
  • People taking prescription medications that reduce bone density.
  • Poor footwear with worn out or nil shock absorption.
  • Vitamin D and calcium deficiencies that weaken your bones.

Symptoms

The most common and generic symptom of a stress fracture is pain in your foot or ankle. Other symptoms associated with the condition may include:

  • Localized pain, swelling and tenderness over the bone.
  • Pain can be dull, sharp or intermittent.
  • You may experience pain during the night.
  • Pain worsens with high impact activity e.g. running, hopping or jumping.
  • Inability to bear weight.

    It may start as a dull pain in the foot or ankle that gradually worsens during physical activity and subsides when you're resting. You will have most likely ignored this pain for a period of time until the intensity of the pain increases and it is causing you significant discomfort. 

    Diagnosis

    We diagnose a stress fracture by taking into account your signs and symptoms and the history of the injury, in conjunction with performing a physical assessment. If we suspect a stress fracture, we refer for X-ray imaging and in some cases an MRI to confirm the diagnosis. 

    Treatment

    If you are showing signs of a stress fracture, we suggest seeing one of our podiatrists to ensure you're started on a treatment plan as soon as possible. The earlier we start treatment, recovery time required will be reduced.  

    Stress fractures usually have multiple factors contributing to the cause of the injury. Therefore, you will often need a personalised combination of the following treatments to allow you to achieve the fastest and most effective recovery so you can return to your regular activities. 

    • The RICE protocol - rest, ice, compression & elevation.
    • Adapt and modify your training program to to ensure further damage doesn't occur. 
    • During the healing process, only engage in low impact activities that won't put pressure on the injury e.g. swimming or bike riding.
    • Supportive footwear with cushioning soles to decrease stress in the area. 
    • Custom prescribed foot orthotics may be recommended to resolve biomechanical issues that are contributing to the fracture and offloading the fracture site.
    • Anti-inflammatory medication.
    • A combination of strengthening and stretching exercises, dry needling and foot mobilisation techniques (FMT) may be recommended before returning to regular activities to ensure the muscles surrounding the area are prepared to take on the physical load.
    • A moon boot may be required depending on the severity and location of the stress fracture.

        Most stress fractures are treated non surgically, however, in severe cases surgical intervention may be required to support the bones by inserting a pin, screw or plate to allow the site to heal. 

        What can happen if I ignore this injury?

        • The microfractures could develop to a complete fracture of the bone
        • The fracture site may not heal
        • Avascular necrosis of the bone (the bone fragments can perish)
        • You may require surgical intervention instead of non invasive treatment

        Prevention

        We recommend the following preventative activities to reduce your risk of developing a stress fracture: 

        • Ensure that you are achieving optimal function in your walking and running patterns.
        • Wear supportive shoes with cushioning and arch support.
        • Replace old and worn out running shoes as they can lose their ability to absorb shock.
        • Maintain a healthy diet rich in calcium and vitamin D to increase bone strength.
        • Start or increase training slowly by gradually increasing time and intensity.
        • Vary your activities to ensure you're not overloading or stressing one area of the body. 

        FAQs

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