Stress fractures are common injuries in runners and athletes, but they can occur in other individuals as well. Athletes who abruptly change their training schedules, break in a new pair of shoes, or run on uneven terrain may experience stress fractures more than others. Individuals who start a new job where they are on their feet for long periods after being inactive can also experience the pain and discomfort of a stress fracture.
What Causes a “Stress Fracture”?
Stress fractures in the feet can have a variety of causes. The most common cause is an abrupt increase in the level of activity. The added stress of constant motion can cause the bones to weaken and break. Bone insufficiency or weakness may also contribute to the occurrence of stress fractures. Another contributing factor may be the lack of conditioning prior to resuming an intense workout schedule. Improper techniques and using the wrong equipment may also contribute to the stress placed on the foot during exercise.
People who are overweight or don't exercise on a regular basis can experience stress fractures as well. In most cases, this type of injury is the result of trying to do too much while the body is unprepared for that level of activity. It's important to know your body's limitations and work within them as much as possible. Always wear the proper shoes for the activity you are performing and take breaks so you don't put an excessive amount of pressure on your feet for long periods of time.
Signs and Symptoms of a Stress Fracture
Unlike a distinct break, a stress fracture can occur over time resulting in a dull, throbbing ache instead of the sharp pain associated with a broken bone. The most common symptoms associated with stress fractures in the feet include:
- Swelling over the top of the foot
- Swelling around the outside of the ankle
- Pain that goes away during rest or when the foot is elevated
- Pain that worsens during normal levels of activity
- Tender to the touch, especially near the site of the break
If a stress fracture occurs, you may experience one or more of the symptoms. Your level of pain and discomfort will depend on several factors. It's important to monitor any pain and discomfort so that you can relay the symptoms to your doctor if the situation worsens.
Diagnosis and Treatment
Stress fractures are diagnosed by using X-rays, MRIs, and bone scans. Because they are not true “breaks” within the bone, it may take several weeks before they will show up on an x-ray. Bone scans are not always conclusive when it comes to bone damage or breaks. Most types of bone injuries or damage tend to look the same with a bone scan making it much harder to detect stress fractures.
An MRI, on the other hand, can detect stress fractures and other abnormalities within a few days of the injury. MRIs can also accurately identify soft tissue injuries in the same area. The radio waves and magnetic field used to detect problems within the body provides a much more accurate picture of what is going on compared to both bone scans and x-rays. Dr. Fihman may use more than one diagnostic method to ensure she is making an accurate diagnosis. The goal isn't just to treat the pain and discomfort but to find the real cause and address it accordingly. This will ensure proper treatment is given and you are given the proper tools to facilitate the healing process.
Because stress fractures most commonly occur on bones that bear the weight of the body during movement or exercise, walking boots, braces, and even crutches may be used to help you avoid placing excessive amounts of pressure on your foot. Stress fractures, in most cases, will heal rapidly if protected. If the fracture occurs in an area where the blood supply is insufficient to support the healing process, surgery may be used to facilitate the process. Although surgery for stress fractures is extremely rare, athletes may opt for the procedure if it will ensure they can return to the field much sooner than later.
Stress fractures can occur without a person realizing they have broken or damaged a bone. Unless they seek medical treatment, they may believe they have simply bruised their foot. If a stress fracture occurs and it goes untreated for long periods of time, the small fracture may grow in size and eventually break. This can cause intense pain, inflammation, and if the damage to the bone is extensive, surgery may be required to set it in place so it can heal properly. The longer the fracture goes without being able to heal, the longer your recovery time will be.
If a person receives a stress fracture in their foot, odds are that other bones in the area will be more susceptible to stress fractures in the future. This can mean long-term issues if the fractures tend to go unnoticed. Repeated damage to bones can lead to osteoarthritis and chronic pain. A person who has been diagnosed with degenerative bone disease may be more susceptible to stress fractures, as well as strains and sprains, as the bones and connective tissues continue to weaken. It's important to discuss these issues with your doctor so you are better able to prevent injuries in the future.
Because a stress fracture is not considered a complete fracture, the recovery time is often less than it would be for a more severe break. Where a compound break can take up to eight weeks to heal, a stress fracture can heal in as little as four to six weeks if proper care is provided. The patient will also need to keep the foot immobilized either through the use of a brace or boot and follow Dr. Fihman's orders as they pertain to the care of your injury. Even though your foot may be feeling better, following her orders will protect you from re-injuring the area before it has a chance to fully recover.
While certain forms of exercise are allowed, no attempts should be made to put an excessive amount of weight on the injured area until Dr. Fihman believes the injury is healed enough to support it. With stress fractures, it's often recommended to forego any weight-bearing activities for at least two to three weeks to allow the bone to begin to heal and regain its strength. It's important to remember that even though the pain and inflammation may have dissipated, the area may not be fully healed. Always follow Dr. Fihman's orders before returning to your normal exercise routine to prevent re-injuring the area and causing further damage.
If you have suffered from stress fractures in the past and know that you are susceptible to them, there are several precautions you can take to prevent them from occurring. Wear the right types of shoes for the activity you are participating in. Wrap your foot or wear a brace to provide additional support to the area. Try to avoid running or walking on uneven terrain. If you must pass over uneven terrain, carefully place your steps to avoid major fluctuations that will cause your foot to flex more than normal.
If you haven't exercised in a while, don't push yourself too hard. Abrupt changes in your level of activity can also place stress on your foot. Instead of rushing into a new exercise routine, take your time and allow your body to become accustomed to a gradual increase in activity. Dr. Fihman can also provide additional tips on how to prevent repeated stress fractures in the future. She will be able to answer your questions and also recommend braces or taping methods that will be beneficial in preventing future injuries. Taking the necessary precautions to prevent injuries to your feet and ankles can prevent lifelong discomfort and chronic pain that can reduce your quality of life as you age.
Dr. Leonora Fihman offers her services to residents throughout Southern California, including Los Angeles, Beverly Hills, and the San Fernando Valley area. She also provides concierge services to her patients who cannot make it to her office due to their work or simply their inability to travel. Her goal is to provide the highest level of care to each of her patients, giving them the opportunity to play an active role in their healthcare. If you are experiencing pain and discomfort when you walk or in general, call her office today to schedule an appointment. She will perform a thorough examination and discuss your options with you once a diagnosis has been made. Her goal is to make sure you don't have to live your life in pain. Get back on your feet! Schedule your appointment with Dr. Fihman today!