What is a stress fracture?
A stress fracture is a small crack or break in the bone that occurs due to overuse or repetitive stress. It commonly occurs in runners and athletes.
These injuries usually occur when people change their activity levels suddenly such as increased intensity exercise or long distance running without previously being conditioned to it. It can also occur if the bone is weak due to osteoporosis.
Weightbearing surfaces of the bones are particularly susceptible to this injury as they must absorb large forces during jumping, walking and running.
Where do stress fractures commonly occur?
These injuries commonly affect the 2nd or 3rd ray of the foot (metatarsal bone). This is because these bones are thinner and longer compared to the first ray. They also experience greatest impact in the foot as you push off during walking and running.
They can also occur in the heel bone (calcaneus) or the outer bone of the ankle joint (fibula).
What are the causes of?
Common causes are:
Insufficiency of bones -osteoporosis and Vitamin D deficiency can cause weakness of the bones and you are more likely to experience a stress fracture.
Poor Conditioning – an alteration to your normal gait during running may increase the risk of a stress fracture. An example is a blister which may have developed in the sole of your foot may affect how you put weight on your foot and give rise to a stress fracture.
Improper technique – This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet, because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate.
Change in training surface -a change in the playing surface for example from grass to turf, can increase the risk of this condition.
What are the symptoms of a stress fracture?
Pain is the commonest symptom.
Swelling and bruising of the affected region usually the top of the foot.
Tenderness of the affected region
How is the fracture diagnosed?
A clinical examination and Xrays are necessary. In some fractures a CT or MRI scan may be required to confirm the diagnosis.
What treatment options are there?
Most stress fractures will respond to non surgical treatment initially. This involves:
Rest and protected weight bearing – a special boot will be provided to you to walk in. In some cases you may be asked to avoid walking on the affected foot for 3 to 4 weeks to allow it to heal
Reduction in activity/exercise levels
Will I need surgery?
Surgery is only occasionally necessary. It is required if the bone shows no signs of healing over a prolonged duration of time. Mr Shariff will discuss your options in greater detail with you.