Stress Fractures

What is a stress fracture?

 Many stress fractures are overuse injuries.  A stress fracture is a small crack or bruise in the bone.  This is a common injury in runners and athletes who participate in sports such as soccer and basketball.  Stress fractures commonly occur when people change their activities, such as trying a new exercise, increasing the intensity of their workouts or changing the workout surface.  If the patient has osteoporosis or other diseases that may weaken the bones, just doing everyday activities may result in a stress fracture.  The weightbearing bones of the foot and lower leg are especially vulnerable to stress fractures because of the repetitive forces they must absorb during activities like walking, running, and jumping.  The key to recovering from a stress fracture is refraining from high impact activities for an adequate period of time.  Returning to activity too quickly can not only delay the healing process, but also increases the risk for a complete fracture.  A complete fracture takes longer to recover from and return to activities.  The most common location for a stress fracture in the foot is the second and third metatarsals in the foot, which is thinner and often longer than the adjacent first metatarsal.  This is the area of greatest impact on your foot as you push off when you walk or run. 

What causes a stress fracture?

The most common cause for a stress fracture is a sudden increase in physical activity.  There can be an increase in frequency of activity as well as in duration or intensity of activity.  There are several other factors that cause stress fractures such as:

  • Bone Insufficiency- Osteoporosis is a condition that decreases bone strength and density, which contribute to stress fractures. Also certain long term medications can make you more likely to experience a stress fracture. 
  • Poor conditioning- Stress fractures commonly occur in patients who are just beginning an exercise program and do too much too soon. Stress fractures also occur when athletes push through any discomfort and do not allow their bodies to recover from any pain or injury.
  • Improper Technique- foot biomechanics such as the way it absorbs impact as it strikes the ground can increase the risk of a stress fracture. Also if the patient has an underlying foot deformity or pathology such as blister, bunion, or tendinitis, it can alter gait and it may require an area of bone to bear more pressure than usual.
  • Change in Surface- there is a risk of a stress fracture when you change your training or playing surface. For instance when a runner changes from a treadmill to an outdoor track or a tennis player from a grass court to a hard court. 
  • Improper Equipment-wearing old and non-supportive shoes that have lost their shock-absorbing ability may contribute to stress fractures.

What are symptoms of a stress fracture?

            The most common symptom is pain, especially with weight-bearing activity.  Pain usually diminishes with rest.  There is swelling and sometimes bruising.  There is tenderness to touch at the site of the fracture.

Diagnosis of a stress fracture

            A physical examination will be performed where Dr. Fihman will look for areas of tenderness and apply gentle pressure directly to the injured bone.  Pain from a stress fracture is typically limited to the area directly over the injured bone and not over the whole foot.  Radiographs will be taken, but stress fractures are often difficult to see on a first x-ray.  After a few weeks, a type of healing bone called callus may appear around the fracture site and when the fracture line becomes visible on the x-ray.  If a stress fracture is suspected, but is not seen on an x-ray, an MRI will be recommended. 

Treatment of a stress fracture

Conservative treatment includes in addition to the RICE protocol and anti-inflammatory medication, Dr. Fihman will recommend non-weightbearing in either a cam walker boot or a cast depending on the location of the stress fracture.  It typically take from 6 to 8 weeks.