Summer Blog Series: Stress Fractures
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!