Feet > 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:

   Second 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.

   Navicular – 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.

Overuse while 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.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

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 those goals.

Physicians 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.

TESTS

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.