Stress Fractures

Stress Fractures: When a Sore Foot is More Than Just a Sore Foot

   A brand new year is just around the corner and this means it is time once again for New Year resolutions! One of the most popular and most important resolutions we can make is to improve our health by eating better and by exercising more. While both of these are wonderful promises to make to ourselves, over-use injuries in the foot can occur from sudden increases in exercise. It is important to recognize when you may have one of these injuries so you can seek treatment and avoid serious complications in the future.

Stress fractures of the foot are commonly misdiagnosed or the diagnosis is missed altogether because signs and symptoms can be mild in the beginning stages of the fracture.  A stress fracture is a type of overuse injury where the muscles of the foot or leg do not take on the amount of force required and the excess force is transferred to the bone.  This occurs with increases in frequency, intensity or duration of activity which loads the bones of the foot or ankle with more force than they can handle.  This results in an incomplete crack or fracture of the bone known as a stress fracture.  A patient may report they feel an increasing sense of soreness to the top of the foot that began after a period of increased or changed activity level.  The pain is particularly worse with exercise activities but day-to-day activities are becoming painful as well. The discomfort is relieved with rest and is generally not felt when one is not on their feet. There may be some swelling and redness that accompanies the pain which can cause shoes to be uncomfortable.

Upon physical examination by a well-trained physician, a spot-specific point of moderate to severe pain is revealed that is generally located directly over one of the five long bones of the foot (metatarsals).  The metatarsals are the most common location of stress fractures however it is possible to have a stress fracture of other bones of the foot and ankle. If vibration or ultrasound is placed over the suspected stress fracture site, often pain will be reproduced.  X-rays are often negative for any significant findings. This is because stress fracture lines are very fine and it can take up to three weeks for bone healing to be visible. This delay in fracture visibility can cause many physicians to draw the conclusion that the x-ray is negative and the patient is experiencing a “sprain” or “strain” of the foot.  This may result in the patient being discharged without the proper immobilization, instruction and follow-up care. As podiatrists, we realize that the diagnosis of a stress fracture is made primarily from the presence of clinical signs and positive x-ray findings may or may not be present.

If the diagnosis of a stress fracture is made, it is important that the patient is placed in proper immobilization such as a stiff-soled surgical shoe or walking cast for a number of weeks to allow the fracture to heal. The physician will evaluate fracture healing by interviewing the patient again in a couple of weeks to assess their pain level and progress and by repeating x-rays of the fracture site.  If the stress fracture is not cared for appropriately, it can turn into a full fracture that travels all the way through the bone causing the fracture to become displaced. This is a bad situation as it could require several weeks or months of non-weight bearing in a cast or even require surgery utilizing plates and screws to realign the fracture.

There are many factors that can contribute to the development of stress fractures such as diet, the presence of osteoporosis, activity level, foot biomechanics and the type of shoes one wears. If you are embarking on a new diet and exercise program for 2012, congratulations and good luck! It is important to make sure you are getting the proper amount of nutrients and minerals in your new diet to promote and maintain bone and muscle health as well as energy levels. Before beginning any exercise program you should make sure you are in the correct shoes for the activity you are planning to perform and the correct shoes for your foot type.  This will make your workouts more beneficial for your body and less likely to cause injury. If you are unsure of what shoes are right for you, we are happy to help. Have a Happy Healthy 2013!!