Pain in the mid-foot? You may have a stress fracture!

March 25, 2010 Posted by Dr.Murray

Stress fractures can result from a number of reasons. Most common causes for stress fractures are decreased bone density, post-op complications from a foot surgery, and athletic training error / overuse injury in athletes, dancers, and “weekend warriors.” It typically occurs in the second metatarsal…. The longest of all central foot bones and the one subject to the most loading forces. Since the second metatarsal tends to carry more of the body’s weight during athletic and dance activities, the increase in pressure results in osteoclastic activity and compensatory osteoblastic activity becoming imbalanced.

– Increasing pain in the midfoot
– Pain at rest
– Pain during activities
– Swelling on the dorsum of the foot
There is a lack of physical signs in making this diagnosis. Stress fractures cannot be seen on plain film x-rays until a few weeks later when healing begins. For this reason, when patients present with the associated signs and symptoms podiatrists often prefer the use of bone scans that typically reveal hot spots in the area of the mid-foot in patients with common stress fractures. CT’s and MRI’s are also helpful in pinpointing the exact location of the stress fracture.
Upon diagnosis, the hallmark of treatment is immobilization through a casting boot for up to 3-4 weeks. Follow this with progressive ambulation and support in customized orthotics or shoe padding for 4-6 weeks and an intermission of the associated activity to promote healing. For the competitive athletes that require a faster recovery time, podiatrists may consider a bone growth stimulator to expedite the healing process. Anti-inflammatory drugs are also given to assist in relieving the pain associated with these fractures. Conservative management is usually successful when treating stress fractures and surgery is rarely required. Use of menthol cooling gels, like Biofreeze, has shown to be helpful in alleviating pain.
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