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  • Writer's pictureDr. Ndidi Ufondu, DPM

Stress Fractures


What are Stress Fractures?

A stress fracture is a small crack or severe bruising within a bone. These injuries are commonly caused by overuse and repetitive forces on the bones of the feet and legs. Unlike full fractures, stress fractures are hairline cracks that develop gradually due to excessive force being placed on a bone over time.

Stress fractures often occur in the weight-bearing bones of the foot and lower leg, such as the metatarsals, calcaneus (heel bone), and tibial shaft. They are common overuse injuries seen in runners, dancers, military recruits, and athletes participating in high-impact sports like basketball and tennis.


Causes of Stress Fractures



Overuse

The most common cause of stress fractures is overuse or repetitive stress on a bone without allowing sufficient time for recovery and bone remodeling. This can happen when someone significantly increases their activity level too quickly, initiates a new high-impact exercise routine, or has poor training habits.


Biomechanical Abnormalities

Foot and ankle structural abnormalities like flat feet, high arched feet, and abnormal gait patterns can lead to altered force distribution and increased stress on certain bones. This makes those areas more susceptible to developing stress fractures.


Nutritional Deficiencies

Having deficiencies in calcium, vitamin D, protein, and other nutrients important for bone health can increase the risk of stress fractures by weakening bones and impairing their ability to handle repeated impact and strain.


Hormonal Factors

Conditions like amenorrhea (absence of menstrual periods) in female athletes and reduced estrogen levels associated with low body weight can lead to lower bone mass and increased susceptibility to stress fractures.


Previous Stress Fractures

Those who have suffered from stress fractures before are at higher risk of developing new stress fractures, especially if the original injury did not fully heal.


Symptoms of Stress Fractures



The main symptom of a stress fracture is pain, which usually:

  • Starts as a dull ache that intensifies during weight-bearing activities

  • May subside with rest initially but worsens over time

  • Becomes sharp and localized over the area of the fracture

  • Is worse at the beginning of an activity after rest

  • May cause swelling around the affected area

Other potential symptoms include:

  • Tenderness and pinpoint pain when touching the area

  • Visible bruising on the skin

  • Difficulty bearing weight on the affected limb

Diagnosis and Treatment



Diagnosis starts with a review of your symptoms, physical examination, and medical history. Imaging tests like x-rays, bone scans, CT scans, and MRI may be ordered to locate and confirm the fracture.


Treatment

Treatment for stress fractures aims to relieve pain, facilitate healing, and prevent further injury. It typically involves:


  • Rest: Resting and avoiding weight-bearing on the affected limb is crucial for allowing the bone to heal properly. How long rest is required depends on the location and severity of the fracture.

  • Immobilization: In some cases, the affected limb may need to be immobilized with a cast, walking boot, or crutches to prevent movement at the fracture site during healing.

  • Medication: Anti-inflammatory drugs like ibuprofen can help reduce pain and inflammation. In more severe cases, your doctor may prescribe stronger pain relievers.

  • Orthotics: Getting custom orthotic shoe inserts or braces may be recommended to correct biomechanical issues and redistribute weight and impact forces.

Modalities

Your podiatrist may use therapeutic ultrasound, electrical stimulation, and other modalities to stimulate bone healing.


Surgical Treatment

In very rare cases of severe, complicated, or non-healing stress fractures, surgery may be considered to stabilize the bone and allow healing. However, this is highly uncommon and would only be done by an orthopedic surgeon, not a podiatric clinic.


Returning to Activity



Return to activity must happen gradually and only once the bone has completely healed as confirmed by your podiatrist. Going back too soon risks re-injury.

A customized rehabilitation program focusing on stretching, strengthening, gradual impact and weight-bearing exercises, and correcting any training errors is essential. Your podiatrist will guide you through the process.


Prevention

To reduce your risk of developing stress fractures:

  • Increase activity levels gradually

  • Use proper footwear and replace shoes regularly

  • Cross-train to avoid excessive repetitive forces

  • Maintain ideal body weight and good nutrition

  • Allow for rest and recovery between workouts

  • Work on flexibility, strength, and conditioning

  • Have your biomechanics professionally assessed

  • Follow training program guidelines if an athlete

Key Takeaways

  • Stress fractures are tiny cracks in a bone from repetitive overuse

  • They often occur in the weight-bearing bones of the feet and legs

  • Causes include overuse, biomechanical issues, nutrition, hormones

  • Pain, swelling, and tenderness are main symptoms

  • Treatment involves rest, immobilization, meds, custom orthotics

  • Surgery is very rarely needed for complicated cases

  • Allowing full healing and proper rehab is crucial before returning to activities

  • Prevention focuses on training smart, footwear, nutrition, and biomechanics

FAQs


How long does it take for a stress fracture to heal?

Healing times can vary from 4-12 weeks or more depending on the location, severity of the injury, your overall health, and if you adhere to the treatment plan. Metatarsal fractures may take longer to heal.


Can you walk on a stress fracture?

Walking should be very limited or avoided entirely to prevent further injury and allow the fracture to heal properly. Crutches may be needed for a period of non-weight bearing.


Do stress fractures always show up on x-rays?

No, stress fractures are often difficult to see on initial x-rays as they are so small. Further imaging like bone scans or MRIs may be needed for diagnosis.


Can stress fractures heal on their own without treatment?

It is very unlikely a stress fracture will heal properly without appropriate rest and treatment. Continuing activities before it heals risks displaced fractures and more serious injury.


How can I prevent future stress fractures?

Focus on smart training, using proper footwear, building up activity gradually, correcting biomechanical issues, maintaining bone health through diet/nutrition, and allowing for adequate rest and recovery.

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