Stress fractures differ from regular fractures in that they are cracks in the bone opposed to a complete break through the bone. Stress fractures are very common in the foot and lower extremity due to the mechanical load from our bodies. In the foot they are most commonly seen in the second and third metatarsals. Overuse and repetitive forces cause stress fractures. This overuse can be from a runner who increases their mileage too quickly or from any increase in activity or change in activity.
People who suffer from stress fractures generally have pain in a very specific spot on their foot, ankle, or leg. Diagnosis can be a little tricky in that stress fractures are not seen right away on x-rays. This takes a couple of weeks to visualize and by the time it is seen on x-ray, the stress fracture has already started to heal. The healing of the stress fracture seen on x-ray is called callus formation. To get more of a definitive diagnosis of a stress fracture right away your doctor can order an MRI or bone scan.
Treatment for stress fractures is rest. If a patient was to continue their increased activity while having a stress fracture this could result in a complete fracture and would increase the recovery time. Sometimes your doctor may put you in a surgical shoe or walking boot in order to decrease the stress. Ice and elevation are also important for the recovery process. For those who wish to keep their conditioning up while recovering from a stress fracture, aqua jogging and swimming can be good options.
–Dr. Colleen Law
Orthotics are commonly suggested aides to recovery and injury prevention. Orthotic shoe inserts control the motion between the forefoot and the rear foot, evenly distributing the weight and pressure exerted on the foot. They reduce excessive motion that may occur in certain feet, they can act as a binding force that absorbs strain as pressure is exerted on them, and they can accommodate and cushion painful or injured areas. “While not everyone needs orthotics,” Dr. Murray notes, “they are a highly successful conservative treatment strategy for certain types of feet and foot conditions.” For problems ranging from structural deformities, such as bunions, to conditions such as posterior tibial tendonitis, orthotics are an economic way to both treat pain and prevent further injuries.
Through their forty years of combined experience in working with Charlottesvillian feet, Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries. The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet.
If you suspect that you need orthotics or if you have foot pain, a first visit will include a foot examination, as well as an examination of your shoes. That’s right, bring your shoes to your appointment. The reason being is that the number one cause of foot pain and related injuries is worn out shoes. “Shoes are just not made to be worn forever,” comments Charlottesville shoe guru, Mark Lorenzoni of Ragged Mountain Running. Lorenzoni, a veteran runner and long-time shoe salesman, argues that you should be just as wary of your daily shoes as you are of your athletic shoes. Shoes should be sized properly in regard to the width of the different parts of your foot as well as your gait, your arch, and any propensities your foot may have to pronate. Shoes support your foot by guiding its motion.
If you did not consider which shoes are best for your individual feet, or if you wore out your shoes and kept using them, you may be experiencing a host of problems. Shoes that are too loose can cause blisters or problems with your Achilles tendon; shoes that are too tight could cause plantar fasciitis or aggravate bunions and bursitis; shoes too wide could cause problems in the ankle of people who pronate, and shoes too tight could cause ankle pain in a supinator. So if you come in telling Dr. Chang and Dr. Murray that you have kept working out in over-worn or ill-fitted shoes, they may just send you back to Lorenzoni’s shop. There, a number of trained shoe experts will conduct a gait analysis and draw on their years of expertise in the industry to match your feet to the proper shoe. And a time-saving strategy may be just trying new shoes and replacing your shoes every 200-400 miles, according to the chart below. The good news is that purchasing new shoes is often a complete solution to burgeoning foot pain! The shoe mileage chart below, created by the family at Ragged Mountain Running Shop, can help you sort out when to replace your shoes.
| Shoe Mileage Chart
Over half the injuries runners and walkers experience can be directly attributed to “worn out shoes”. Worn out refers to the midsole (engine) of the shoe, which is the most important component of an athletic shoe. Don’t use the outsole/tread wear as a way of determining how much life is left in your shoes! This midsole component generally lasts about 375-450 miles of athletic use. Cut that mileage rating in half if you choose in addition to use your shoes for anything other than your running or walking exercise (i.e. “wearing around”). Here is a sample mileage chart to determine how often you might need to replace your exercise shoes.
*Created by the family at Ragged Mountain Running Shop*
New shoes, however, may not solve all your foot pain. If you still feel pain after you try out your spiffy new, well-fit shoes, it is time to visit your Charlottesville podiatrist. To get closer to the root of your foot pain problem, Dr. Murray and Dr. Chang are likely to suggest that you wear an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic to test whether a pair of custom-made orthotics will help you. Orthotics last about 5 years (depending on use), they lessen the likelihood of injuries, reduce doctors visits, and relieve pain.
The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics correct for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will scan your foot and write a customized prescription for your orthotics to fit your orthotics’ purpose and your intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head to ensure you go home with the right product.
The process to begin wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six-month warranty with the lab that makes them.
But it all comes back to shoes. Truth be told, orthotics are only as good as the shoes in which they are inserted. Make sure that your footwear is foot-friendly and accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic. Note that not all shoes are made to accommodate orthotics, no matter the brand, style, or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices. Although one pair of orthotics can be used in multiple pairs of shoes, most patients purchase multiple pairs of orthitcs to fit a variety of shoes.
As sand and dirt can abrade them, reducing their functional period, wash your orthotics every two weeks with mild soap and lukewarm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.
Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Orthotics are affordable and last for years, and prevent a host of conditions, from runner’s knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and all-around successful treatment technique. Orthotics are only helpful when used, so Dr. Murray and Dr. Chang suggest that you wear orthotics continually to reduce pain and to improve your posture and alignment.Blue Ridge Foot and Ankle Clinic 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 417 South Magnolia AveWaynesboro, VA 22980 540-949-5150 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
- Posted in Athletic Injury, Blisters, Bunions, Children, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, Foot Doctor, Foot Pain, Heel Pain, Leg pain, Orthotics, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shockwave Therapy, Shoes, Shoes and Socks, Stress Fractures
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Shin splints, also called tibial stress syndrome, are a common complaint of runners who increase their mileage or intensity too quickly. Feeling throbbing or aching in the shins is surprisingly common for athletes and runners. Shin splints, however, aren’t a single medical condition. They can be caused by a number of factors; irritated and swollen muscles, over use, stress fractures, over-pronation or flat feet, and running on hard surfaces, to name a few. With shin splints you will feel a dull and aching pain in the front of the lower leg during exercise, or even after exercise. Shins may be painful to the touch, muscles can swell, and nerves can even be affected causing parts of the feet to go numb.
There are various places where the shin can cause pain. Usually, a flatfoot can cause pain in the tibialis posterior, or the front and outside of your shin. High arches can cause anterior lateral shin splints, on the inside of your shin. Less common is pain deep in the back
of the leg, caused by tightness in your inner calf muscles, the soleal complex. No matter what kind, shin splints are a mechanical issue, caused by excessive mileage and a pounding stride.
There is good news for all of you who suffer from shin splints: they are very treatable, with quite high success rates! So have hope as you begin your treatment plan. Treatment for shin splints varies according to the nature of your own individual injury. In general, the very first thing to do is to rest in order for your injury to heal. Additionally, ice, NSAIDs, arch supports, range of motion exercises (as recommended by your podiatrist or physical therapist), a neoprene sleeve to support and warm the leg, and physical therapy will be recommended. If your shin splints are caused by stress fractures, you may be put in a walking boot or even need surgery for severe cases.
Remember that recovering from shin splints can be a frustratingly long process. Many runners need up to six months, or more, to recover. Resist the urge to start running again before you are ready, because your injury could become more severe. To bide time and to stay in shape until you heal, you can take up activities that have little impact on your legs such as swimming or cycling. You will know when you are ready to run again by a number of factors including equal flexibility in your legs, activity does not cause pain, or when x-rays show that your stress fractures have healed. To avoid shin splints wear good shoes with the right amount of support for your foot, warm up and then stretch before working out, run on soft surfaces, and stop working out when you feel pain in your shins.
CALL US TODAY FOR AN APPOINTMENT. WE ARE ACCEPTING NEW PATIENTS.
Request a copy of our FREE book from our home page: www.brfootandankle.comBlue Ridge Foot and Ankle Clinic 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 & 417 South Magnolia Dr Waynesboro, VA 22980 540-949-5150
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If you have foot or ankle pain, come see us. If you need advice on training, I’m sure the folks at Ragged Mountain Running Shop and Crozet Running Store can help you out. Most importantly, get out there and enjoy yourself.
On Saturday (bright & early in the morning!) Dr. Chang spoke to Charlottesville Women’s 4 Miler Training Program participants about how to maintain healthy feet & ankles while training for the race coming up this Fall. His main piece of advice for them was to be sure they rest. Their training schedule gives them a ‘day off’ on Fridays and he asked that they stick to that so their body can recover and remain injury free. After their training run, many of the ladies came to Dr. Chang for advice on foot and ankle issues that they are already experiencing. We had a great time meeting so many women who are dedicated to getting fit while helping their community at the same time! If you are planning to run the Charlottesville Women’s 4 Miler next year or just want to get started with running, this training program is a great way to do it!
We gave training program participants a flyer with instructions on how to download our free book- A Runner’s Guide To Maintaining Healthy Feet & Ankles. If you would like a copy, you can download it here: www.brfootandankle.com/book
There are two main kinds of fractures of the foot – traumatic (or impact) injuries and overuse (or repetitive stress) injuries. Stress fractures constitute the latter grouping, and most commonly occur in the metatarsals (bones of the mid-foot), the hallmark of which is swelling on the top of the foot. Stress fractures are also common in the ankles and shins. Regardless of where the stress fracture is located, it will be identifiable by pinpoint (not diffuse) pain. With 26 bones, your foot’s complex structure allows many opportunities for stress fractures!
Stress fractures most commonly occur among athletes and runners who increase their mileage too quickly. In general, stick to the 10% increase in mileage per week rule, and you will more likely avoid getting a stress fracture. However, it is also important to keep an eye on other factors that might lead to a stress fracture. These factors include, but are not limited to, poor nutrition, improper footwear, abnormal foot structures, deformities, osteoporosis, and sudden weight gain. Stress fractures are often diagnosed by pain during activity that goes away with rest, pain when pressure is exerted at the site of the fracture, and swelling without bruising.
Be forewarned that stress fractures are microfractures, so small that x-rays do not show positive signs of them until two weeks after the onset of pain, as the bone calcifies in the healing process. There are, however, other subtle indicators that point to fractures as causing pain, one reason why it is so important to consult seasoned podiatrists to get a correct diagnosis for your injury.
The most important thing to consider when treating stress fractures is the time they take to heal. Do not wait to treat stress fractures, or put off visiting your podiatrist for a diagnosis. If treated improperly or ignored, stress fractures will only worsen with time or reoccur. Untreated, or improperly treated stress fractures can lead to deformities that restrict motion and activity, cause arthritis and make shoes incredibly uncomfortable.
Your podiatrist and you can work together to find the proper treatment plan for your injury, which will likely include a combination of rest, immobilization with a caste or rigid shoe, avoiding the aggravating activity, ice, NSAIDs, physical therapy for rehabilitation, and surgery in extreme cases. In general, remember that it takes time to heal stress fractures. Be patient with your body – you will be a much stronger runner if you are able to give your injury the time it needs to heal!
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