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What exactly is a stress fracture?
Stress fractures can occur in the foot due to repetitive pressure in a specific area. Unlike acute fractures that can occur from a direct injury, stress fractures can occur due to repetitive force on the bone over time. The bone will then crack. It can also be called a “deep bone bruise.”
Sometimes, it can be difficult for doctors to diagnose a stress fracture immediately. At times, it can take 3 weeks to see the fracture line on an x-ray. Accurate diagnosis and treatment of stress fractures are so important.
Who is at risk for stress fractures in the foot?
- Runners (especially new runners)
- People who may have osteoporosis
- Military men and women
- People with flatfeet or even high arches who tend to put excessive pressure on one area
- Athletes in general
- Women (due to higher risk for osteopenia)
- Diabetics with neuropathy
- People with positive smoking history
What causes stress fractures to occur?
As I stated before, repetitive injury to an affected bone can cause a stress fracture. It’s important to understand that the bones in the human body need time to rebuild and remodel. Sometimes, doing too much too soon doesn’t allow your body to heal the way it should.
That’s why stress fractures are also known as “fatigue” fractures. The bone is essentially fatigued and weakens, causing it to break.
What are some of the symptoms of a stress fracture?
- Progressive dull, achy pain in a specific area of the foot
- Swelling at the site of fracture
- Pain that occurs with activity, but improves with rest
- Bruising at the site of fracture
Common areas for stress fractures in the foot
- Metatarsal stress fractures
- Stress fractures of the heel bone
- Stress fractures of the midfoot
- Stress fractures of the ankle
Stress fractures of the metatarsal bones
You have five metatarsal bones in each foot. Metatarsal bones are the bones that are in between the bones in the back portion of your foot and your toes.
The second metatarsal bone is a very common area for people to get stress fractures. In most people, this bone is thinner and longer than its adjacent bone. This means that it takes on a lot of stress during activities.
Someone who may be especially at risk for developing a stress fracture in the second metatarsal bone would be a runner. Especially if the runner is a “forefoot” strike runner instead of a “midfoot” strike runner.
The solution to avoiding 2nd metatarsal stress fractures
Orthotics that alleviate pressure from the metatarsal heads and rebalance the foot can help. Also, if you are a runner, focus on landing on the middle of your foot when running, instead of on the ball of your foot.
The fifth metatarsal bone is also a common area for stress fractures. A lot of people naturally put pressure on the side of their feet when walking.
Pro tip: You can check if you put a lot of pressure on the outsides of your feet when walking by checking your shoes. Check your shoe wear pattern. Is there a lot of wear on the outside of your shoes? If yes, then you place a lot of pressure on the outside of your foot when walking.
Read more about how bad shoes can cause foot pain in this detailed guide.
Doing too much activity too soon can cause excessive pressure to be placed on the 5th metatarsal. One unfortunate thing about sustaining stress fractures in the fifth metatarsal is that there is an area in the fifth metatarsal bone that has a poor blood supply, which can make it more difficult to heal. These fractures, called “Jones fractures” can be hard to heal.
The solution to avoiding 5th metatarsal stress fractures
Custom orthotics that rebalance foot pressures can help a lot to keep excessive pressure away from the outsides of your feet.
Read more about metatarsal fractures in a supplemental post Broken Metatarsals in the Foot- A Simple Guide on Management.
Stress fracture of the heel bone (calcaneus):
As you can imagine, there is a tremendous amount of daily pressure that is placed on our heels. It’s not hard to believe that this is a common area to develop stress fractures.
The problem is that most people tend to be unaware that they have a stress fracture in the heel, and may think their pain is related to plantar fasciitis or Achilles tendinitis instead.
It’s important to see a doctor and get an x-ray done if you have persistent pain in the heel. Luckily, the heel bone has great healing potential in most cases as it is well vascularized.
Stress fractures in the midfoot:
You may sustain a stress fracture in the navicular bone (the bone on the inside of the midfoot), the cuneiforms, or cuboid bones. These stress fractures can be hard to visualize and require prompt attention and treatment.
The solution to avoiding midfoot stress fractures
Appropriate orthotics that are well-fitted are needed. Also, an extra forefoot/midfoot cushion on your running shoes may help.
Stress fractures in the ankle:
You may sustain a tibial, fibular, or talar stress fracture. These bones make up the ankle. These stress fractures can cause you to feel a dull, achy persistent pain deep in the ankle.
The solution to avoiding stress fractures of the ankle
In addition to appropriate orthotics, high-top stiff shoes/boots can help stabilize your ankles. This can help prevent injury.
What else can you do to avoid stress fractures?
- Don’t increase your activities too soon. If you know you are going to need to increase your activity for some reason, make sure you train beforehand so your body is ready
- Don’t suddenly get new inserts or new shoes before you decide to increase your activity. Although shoes and insoles don’t change our feet directly, they certainly do change how we walk and place pressure on our feet. Suddenly changing shoes while simultaneously increasing your activity can lead to a stress fracture.
- Don’t wear flimsy shoes. Make sure your shoes are not worn and fit well. Make sure that the extrinsic portion of your shoe (the bottom sole) is supportive and stiff.
- Don’t push through the pain. Our bodies have pain signals for a reason. Make sure to listen to them and stop what you’re doing.
- Make sure your Vitamin D levels are not too low. Talk to your doctor about a supplement if needed.
- If you are having constant pain from running daily, take a couple of weeks off to cross-train. You can try swimming or lifting weights to rest your body and still stay in shape.
What are home remedies for stress fractures?
- RICE Therapy (Rest, Ice, Compress the foot/ankle using ACE bandages or compression stockings, and Elevate the extremity)
- You can soak your feet in warm water with Epsom salt. This won’t heal the fracture but can help with pain.
- Stay off your foot when the pain starts.
- Taping is not very effective for treating stress fractures. Although it may help in some cases, you are better off keeping your foot protected in a cast boot.
How are stress fractures diagnosed?
- Physical exam
Your doctor will want to perform a physical exam and will then be able to pinpoint your target area of pain.
As I stated before stress fractures are not acute fractures. They can take a while to show up on x-ray. Your doctor may order an x-ray and have you come back later in 3-4 weeks to order another one to see if there is a bone “callus” that would suggest a stress fracture. Eventually, the fracture line will be visible.
- MRI or CT scan
Your doctor may order an MRI or CT scan to visualize the stress fractures. These tests can more accurately diagnose the stress fracture, in addition to seeing if there is any tendon/ligament injury.
How are stress fractures treated?
Fracture healing can take 6-8 weeks minimum. If you sustain a stress fracture and the bone is not displaced (shifted), your doctor may have you walk minimally in a cast boot for several weeks.
This United Ortho short cast boot is great because it stabilizes the foot and ankle appropriately.
The short cast boot is often times more comfortable for people to wear than the heavier longer cast boot.
If the pain is excessive, you may need to have a cast put on your leg and stay off the foot completely using crutches or a knee scooter.
Pro tip: After you heal a stress fracture, make sure you get orthotics to rebalance your feet so hopefully this doesn’t happen again
Sometimes surgical treatment is necessary. If the bone is shifted or the fracture occurs in an area that has poor blood supply (like a Jones fracture at the fifth metatarsal) then surgery may be necessary to expedite its ability to heal.
Your doctor may treat your stress fracture by fixing it using screws and plates. You will need to stay off your foot after the repair for 6-8 weeks to ensure adequate healing. After which your doctor will gradually transition you into appropriate shoes/orthotics.
Surgical treatment for stress fractures is not an exact science. A lot depends on the patient, the type of injury, and the area of injury as well.
For instance, a healthy 15-year-old patient with a second metatarsal stress fracture may heal sooner than a 75-year-old uncontrolled diabetic patient with neuropathy who sustains a stress fracture in the fifth metatarsal.
Your doctor will decide how to treat your stress fracture in the best way he or she sees fit. Stress fractures can be incredibly frustrating injuries. Seeking prompt treatment when you think you may have sustained a stress fracture is crucial.
Returning to activity
Make sure to return to activities gradually. You may want to consider taking a rest day between training days. If you still feel pain when trying to increase your activities, take some time off your foot. This can be frustrating when you have life goals in place, but just remember this isn’t forever.
Our bodies need time to recover. Treating stress fractures is important, but it’s also important to take precautions moving forward. Speak to your doctor about what orthotic would be good for your foot structure.
For shoes, ask your doctor or even the people working at your local running shoe store for recommendations.
Can you work with a stress fracture?
As long as you can rest your foot and remain in your cast boot, you may be able to return to work. Of course, heavy weight-bearing demands at certain jobs may not permit this. It’s best to speak to your doctor about his/her recommendations.
Can you experience numbness from stress fractures?
It’s not unusual to break a bone in the body and experience numbness for a while. Our nerves are fairly superficial. Even a little swelling in the foot that occurs secondary to a fracture can cause some numbness. In most cases, this may be temporary.
In conclusion, stress fractures can be painful and frustrating. Although some people are at higher risk for developing stress fractures than others, anyone can get them. Treating your stress fracture is key. Make sure you reach out to your doctor if you suspect that you have a stress fracture.
Have you ever had a stress fracture before? How was it treated? Leave a comment below!
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