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What is a Stress Fracture?
A stress fracture of the foot is a type of bone injury that occurs in the foot as a result of repetitive pressure exerted on a specific area.
Unlike acute fractures caused by direct trauma, stress fractures develop gradually over time due to repetitive forces acting on the bone, eventually leading to a crack. This condition is sometimes referred to as a “deep bone bruise.”
Prompt and accurate diagnosis, as well as appropriate treatment, are crucial in managing stress fractures.
Location of Foot Stress Injuries
- Metatarsal stress fractures
- Stress fractures of the heel bone
- Stress fractures of the midfoot
- Stress fractures of the ankle
Metatarsal Fractures
Stress fractures in the foot often occur in specific locations, particularly within the five metatarsal bones of each foot. These metatarsal bones are situated in the front portion of the foot. They connect the toes to the midfoot.
Among these bones, the second metatarsal is a commonly affected area for stress fractures. Compared to its neighboring bones, this particular metatarsal is often longer and thinner, making it more susceptible to stress during various activities.
Runners, especially those who adopt a “forefoot” strike pattern rather than a “midfoot” strike, have an increased risk of developing stress fractures in the second metatarsal bone.
Read more about metatarsal fractures in a supplemental post Broken Metatarsals in the Foot- A Simple Guide on Management.
Stress fractures frequently occur in the fifth metatarsal bone as well. Many individuals naturally exert pressure on the side of their feet while walking, and engaging in excessive activity too quickly can lead to excessive strain on the fifth metatarsal.
Unfortunately, sustaining stress fractures in this area can pose challenges for healing due to a region within the fifth metatarsal bone having limited blood supply. These specific fractures, known as “Jones fractures,” can prove to be particularly difficult to heal.
Stress Fracture of the Big Toe
In addition to stress fractures in the metatarsal bones, stress fractures can also occur in the big toe. While less common than metatarsal stress fractures, the big toe is still susceptible to this type of injury.
Stress fractures in the big toe can be caused by repetitive force or pressure, often from activities that involve push-off and propulsion, such as running or jumping.
It’s important to recognize and address stress fractures in the big toe promptly, as they can lead to significant pain and discomfort.
Midfoot
Within the midfoot region, there are several bones that can be prone to stress fractures, including the navicular bone located on the inner side, as well as the cuneiform and cuboid bones.
Stress fractures in these specific areas can present challenges in terms of visualization and diagnosis, often requiring immediate attention and appropriate treatment to prevent further damage at the fracture site.
Calcaneus
The calcaneus, or heel bone, endures significant pressure on a daily basis, making it a common site for the development of stress fractures. Interestingly, many individuals with a stress fracture in the heel are often unaware of their condition and may attribute their pain to conditions like plantar fasciitis or Achilles tendinitis.
Fortunately, the heel bone generally possesses excellent healing capabilities as it is well supplied with blood vessels, allowing for effective recovery in most cases.
Ankle
The ankle is a complex joint composed of the tibia, fibula, and talus bones, which collectively support the weight of the body and facilitate movement. Within the ankle, stress fractures can occur in these specific bones, namely the tibia, fibula, and talus.
Ankle fractures can result in deep, persistent pain that is often described as dull and achy. An ankle fracture can often be a missed diagnosis due to vague symptoms that the individual may experience.
Causes
As mentioned earlier, the occurrence of a stress fracture is often a result of repetitive stress or injury to a particular bone This is precisely why stress fractures are sometimes referred to as “fatigue” fractures. The bone becomes fatigued and weakened, ultimately leading to its fracture.
Risk Factors
- Runners (especially new runners): New runners are at an increased risk of stress fractures due to the sudden increase in physical activity and inadequate conditioning of their bones and muscles.
- People who may have osteoporosis: Osteoporosis leads to weakened bones, making individuals more susceptible to stress fractures even with minor repetitive activities or normal daily stresses.
- Hikers: The repetitive impact and stress on the feet and legs during hiking can increase the likelihood of developing stress fractures, particularly in individuals who are not accustomed to long-distance walking or have improper footwear.
- Military men and women: The intense physical training and rigorous activities demanded in military service can subject soldiers to repetitive stresses, increasing their vulnerability to stress fractures.
- People with flat feet or high arches who tend to put excessive pressure on one area: Flat feet or high arches can lead to abnormal weight distribution and biomechanical imbalances, placing excessive stress on specific bones and increasing the risk of stress fractures.
- Gymnasts: The high-impact landings, jumps, and repetitive weight-bearing movements involved in gymnastics can contribute to the development of stress fractures, particularly in the feet and lower legs.
- Dancers: Dancers frequently perform repetitive movements and put significant stress on their feet and legs, making them prone to stress fractures, especially in areas subjected to repetitive impacts or overuse.
- Athletes in general: Athletes who engage in repetitive or high-impact activities, such as running, jumping, or sprinting, are at a higher risk of stress fractures due to the repetitive strain placed on their bones.
- Women (due to higher risk for osteopenia): Women, particularly postmenopausal women, have a higher risk of developing osteopenia (low bone density), which can increase the susceptibility to stress fractures.
- Diabetics with neuropathy: Diabetic individuals with neuropathy (nerve damage) may have decreased sensation in their feet, which can lead to excessive pressure and trauma on the bones, increasing the risk of stress fractures.
- People with a positive smoking history: Smoking negatively affects bone health by reducing blood supply and impairing bone healing, making individuals with a history of smoking more susceptible to stress fractures.
Symptoms of a Fracture
- Progressive dull, achy pain in a specific area of the foot
- Swelling at the site of the fracture
- Pain that occurs with activity but improves with rest
- Bruising at the site of the fracture
Diagnosis
- Physical Examination
During a physical exam, your doctor will carefully assess your symptoms and conduct a thorough examination to identify the precise area of pain or tenderness.
- Radiographs
Stress fractures differ from acute fractures in that they may not be immediately visible on an x-ray. Your doctor may request an initial x-ray and schedule a follow-up appointment in 3-4 weeks to detect the presence of a bone “callus” that indicates a stress fracture. Eventually, the fracture line becomes visible on x-ray.
- MRI or CT Scan
Both MRI and CT scans are valuable imaging techniques for diagnosing foot stress fractures. MRI provides detailed images of soft tissues, including tendons, ligaments, and muscles, allowing for the evaluation of associated injuries and complications.
It aids in differentiating stress fractures from other conditions and provides high-resolution information on the extent and severity of the fracture.
On the other hand, CT scans excel in visualizing bones and detecting fractures, providing precise three-dimensional images that outline the location, size, and configuration of the stress fracture.
CT scans help determine the need for surgical intervention and identify potential complications related to the fracture.
- Stress fracture in the foot test
To aid in the diagnosis, a specialized test called a “stress fracture in foot test” may be conducted. During this test, your doctor will apply pressure or tap on the suspected area of the foot to elicit pain.
Additionally, they may perform a tuning fork test, where a tuning fork is placed against the bone to assess for increased pain sensitivity. These tests can help pinpoint the location of the stress fracture and provide helpful information for diagnosis.
By utilizing a combination of physical examination and imaging tests, healthcare providers can effectively diagnose stress fractures and determine the appropriate course of treatment.
Treatment
Non-Surgical Treatment
The healing process for stress fractures typically takes a minimum of 6-8 weeks. If you have a stress fracture without any bone displacement, your doctor may recommend minimal walking while wearing a cast boot for several weeks.
The United Ortho short cast boot is an excellent choice as it provides appropriate stabilization for the foot and ankle. Many individuals find the short cast boot more comfortable compared to the heavier and longer cast boot.
In cases where the pain is severe, your doctor may advise using crutches or a knee scooter and completely avoiding weight-bearing on the foot. After recovering from a stress fracture, it is advisable to use orthotics to rebalance your feet and minimize the chances of a recurrence.
Orthotics play a crucial role in stress fracture treatment by alleviating pressure from the metatarsal heads and rebalancing the foot. The fifth metatarsal bone is susceptible to fractures due to lateral foot pressure while walking.
Evaluating shoe wear patterns can indicate excessive pressure on the foot’s outer edge. Custom orthotics are recommended to redistribute foot pressures.
Additionally, using forefoot or midfoot cushions and opting for high-top stiff shoes or boots provide further support and prevent injuries.
For runners, adopting a midfoot landing technique reduces the risk of stress fractures.
Surgical Treatment
In certain cases, surgical intervention may be necessary. If there is bone displacement or the fracture occurs in an area with poor blood supply, such as a Jones fracture at the fifth metatarsal, surgery may be recommended to expedite the healing process.
Your doctor might opt for fixing the stress fracture using screws and plates.
After the surgical repair, you will need to avoid weight-bearing on the foot for 6-8 weeks to ensure proper healing.
Your doctor will gradually transition you into appropriate shoes and orthotics as part of the recovery process. It’s important to note that surgical treatment for stress fractures is not a one-size-fits-all approach and depends on various factors, including the patient’s condition, the type and location of the injury.
Your doctor will determine the most suitable treatment plan for your stress fracture. Prompt medical attention when suspecting a stress fracture is crucial, as early treatment leads to better outcomes.
Stress Fractures Healing Time
The healing time for stress fractures can vary depending on various factors such as the location and severity of the fracture, individual healing capacity, and adherence to treatment. Generally, stress fractures require a minimum of 6-8 weeks to heal.
Preventing a Stress Fracture
- Don’t increase your activities too soon. Prior training and conditioning can prepare your body for increased activity.
- Avoid sudden changes in footwear or inserts when increasing activity to prevent stress fractures.
- Ensure your shoes are in good condition, properly fitted, and provide sufficient support and rigidity.
- Listen to your body and don’t push through pain signals.
- Maintain adequate Vitamin D levels and consult with a healthcare professional about supplements if needed.
- If experiencing constant pain from running, take a couple of weeks off to cross-train with activities like swimming or weightlifting to rest your body while staying active.
Can You Work With a Stress Injury?
Working with a stress fracture is possible if you can adequately rest your foot and wear a cast boot. However, it’s important to consider the weight-bearing requirements of your job, as some occupations may not be suitable during the healing process.
To determine the best course of action, it is advisable to consult with your doctor and follow their recommendations.
Can You Experience Numbness From Stress Fractures?
Is it possible to experience numbness from stress fractures? It is not uncommon to have temporary numbness after breaking a bone. Nerves in our body are located close to the surface, so even slight swelling from a fracture in the foot can cause temporary numbness. In most cases, the numbness will subside over time.
When Should You See a Healthcare Provider for a Broken Bone That Is Causing Pain?
If you are experiencing pain from a suspected broken bone, it is advisable to seek medical attention promptly. A healthcare provider can accurately diagnose the condition and determine the appropriate course of treatment. Early intervention for broken bones leads to better outcomes and helps prevent complications.
Conclusion
In conclusion, stress fractures of the foot are a common and often overlooked type of bone injury that can significantly impact an individual’s mobility and overall well-being. This medically reviewed article has provided comprehensive information on the causes, symptoms, diagnosis, and treatment options for stress fractures in various foot bones.
By raising awareness about these popular topics and emphasizing the importance of early medical care, individuals experiencing foot pain or related symptoms can be better informed and empowered to seek appropriate treatment. Ongoing research and advancements in medicine continue to enhance our understanding of stress fractures, enabling healthcare providers to offer effective care and support.
Remember, taking proactive measures and listening to your body can help prevent foot problems and ensure a healthy and pain-free ability to walk.
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