> Stress Fracture
What is a Stress Fracture?
Stress fracture is the
term used to describe an overuse injury in the bones
of your foot. A stress fracture is a type of damage
that accrues over time when your foot is unable to withstand
repetitive, minor stress. Physicians describe this stress
as "subthreshold." When subthreshold stress
is repeatedly put on a bone in your foot, that bone
can suffer a stress fracture if the bone’s threshold
for damage is reached over time. All 28 bones in your
foot are subject to stress, and stress fractures can
occur in many places. Recreational and competitive athletes
suffer foot stress fractures in two common areas:
metatarsal – The long bone attached to your second
toe commonly suffers stress fractures in its base, located
in the middle of your foot. The narrow neck of this
bone also commonly succumbs to stress fractures.
– The bone in the middle of the inside of your
foot that forms your arch commonly suffers a stress
fracture in the center of the bone.
running is the most common cause of foot stress fractures
for people who are active. Most sports involve running
either during a game or while training, which makes
foot stress fractures common in many sports. Stress
fractures are common in runners and dancers, but they
can happen to anyone who has sustained, rhythmic pounding
on his or her feet. Increasing your training regimen
or changing the surface you run upon can increase the
force repeatedly applied through your foot and increase
your risk of a stress fracture. Any subtle change in
the shape of your foot, which may happen after an injury,
can alter the way force is applied to your foot when
you run. Consequently, a bone that previously was not
heavily stressed during running may suffer a stress
fracture if it is stressed as a result of another injury
or condition. Changing the type of shoe you wear for
running also can increase your risk of suffering a stress
fracture. Switching from one brand of running shoe to
another typically is not a problem, but switching from
a running shoe with good padding and arch support to
a flat cleat, for example, may alter the distribution
of force on your foot as you run.
There usually are three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor may
Your physician likely will ask about your activities,
which may have caused your stress fracture. You will
probably be asked when the soreness or pain began. If
you have had any prior foot injuries, your physician
will ask about treatments you may have tried in the
past. Physicians suspect a stress fracture if you have
a history of low levels of pain in a specific area of
your foot that have worsened with increased activity
over the course of weeks or months. Physicians also
typically ask about other conditions, such as diabetes
and allergies, and medications currently being taken.
You may also be asked about your physical and athletic
goals – information that will help your physician
decide what treatment might be best for you in achieving
often can diagnose a stress fracture by putting direct
pressure on the injured part of your foot, as it usually
will cause discomfort or pain. Some stress fractures,
such as in your navicular bone that creates the arch
of your foot, may only cause a vague, deep-seated pain
when pressed upon. Stress fractures in the arch and
ball of your foot often are more difficult to diagnose.
Your physician also usually examines the shape of your
foot, its alignment with your ankle, and the mechanics
of your stride as you walk. Understanding how your foot
moves can provide clues to your physician about which
bones may be under abnormal stress. Turning your foot
in different directions can pull on the ligaments and
tendons attached to a damaged area of bone and reveal
the location of a stress fracture.
X-rays are the standard test used to diagnose stress
fractures. However, stress fractures can be subtle injuries
in the early stages and may not appear on X-rays. Bone
scans, CT scans or MRI may be needed to properly see
the damaged tissue. Results from these tests are usually
available right away.
If left untreated, stress fractures
tend to increase in severity until the pain becomes
disabling. Over time, an untreated stress fracture can
put you at risk of suffering a fracture in the affected
bone. Even if the pain appears to go away on its own,
without proper treatment, your bones may never have
a chance to heal and they may be vulnerable to reinjury.
Stress fractures typically heal with what physicians
call symptomatic treatment. This basically means treating
your pain with rest and proper support of your foot
bones. The goal of treatment is to put your foot into
a cast, brace, or supportive shoe so you can continue
walking around without feeling pain. Your specific treatment
varies depending on your symptoms. In general, more
severe stress fractures require more immobilization
and a longer rest period. Less severe stress fractures
may heal with relative rest. A stress fracture in your
second metatarsal is typical of those treated symptomatically.
Certain stress fractures are labeled "at-risk"
if there is a risk of suffering complications, such
as complete fracture, bone dislocation, or foot deformity.
A stress fractures in your navicular bone is an example
more likely to be labeled at-risk. You typically need
to use crutches and wear a cast to heal an at-risk stress
fracture. Cast treatment also is commonly used for stress
fractures that damage a joint in your foot. The links
to the left describe stress fracture treatments in detail.