Stress fracture in the foot

Stress fractures are tiny, hairline cracks that can occur in the bones of the leg and feet. They are caused by the repetitive force on the feet, often by overtraining or overuse – such as repeatedly jumping up and down on hard surfaces or running for long distances. Stress fractures can also arise from normal use of a bone that is weak because of conditions such as osteoporosis. Other factors may include improper training habits or surfaces, improper shoes, flatfoot or other foot deformities. These tiny breaks in the bones of the feet can lead to a complete break if left untreated.

Stress fractures are seen most often in the weight-bearing bones of the lower leg and foot. When the feet are subject to greater than normal force, over time it causes an imbalance between the break down and growth of bone. If these bones don’t have enough time to recover, bone cells will break down faster than they can be replaced resulting in tired bones that can easily crack and cause the pain.

Stress fractures most commonly occur in athletes, but anyone can develop a stress fracture. It is estimated that 0.7 to 15 percent of injuries in athletes are stress fractures – and track athletes get the highest number of stress fractures. The annual incidence of stress fractures in athletes and military recruits ranges from five percent to 30 percent, depending on the sport and other risk factors present. Most stress fractures in the foot occur in the calcaneus (heel bone), tarsal bones and metatarsals. The second, third and fourth metatarsals account for 90 percent of metatarsal stress fractures and the first metatarsal accounts for about 10 percent. Stress fractures occur more often in whites than Blacks, and the number increases with age in women and physically active persons.

People with stress fractures have swelling, pain and tenderness in a particular spot on the foot, especially after starting or increasing an exercise program. The symptoms decrease with rest and often get worse and start earlier with each successive workout. As the time progresses, the pain will continue at rest and may get even worse.

Some factors may increase your risk of developing a stress fractures, these include:

Certain sports: Stress fractures are more common in people who participate in sports that have a lot of motion on the feet such as track and field, basketball, tennis or gymnastics.

Increased activity: Stress fractures often occur in anyone who suddenly shifts from a sedentary lifestyle to an active training regimen — such as a military recruit doing intense marching exercises or an athlete who rapidly increases the intensity, duration or frequency of their training sessions.

Foot type: People who have flat feet or high, rigid arches are more likely to develop stress fractures because the feet do not absorb the shock adequately.

Weakened bones: Conditions such as osteoporosis can weaken your bones and make it easier for stress fractures to occur.

While a stress fracture can be diagnosed from the medical history and physical exam alone, imaging studies are often needed to confirm the diagnosis. The podiatrist may order x-rays, bone scans or even an MRI to diagnose a stress fracture. Based on the test ordered, the stress fracture may be seen right away or it may take several weeks to show up.

If you recently started a new exercise program and you have pain in the feet that sounds like it can be a stress fracture, see the podiatrist as soon as possible, if the pain becomes severe or persists even at rest. Early treatment can shorten the recovery time and help you get back to exercising faster.

Treatment for a stress fracture varies depending on the location and how quickly the individual needs to resume their physical activity. It may include the following.

Medications: To relieve the pain take acetaminophen (Tylenol, others) or Panadol. At times an anti-inflammatory medication may be use for a short time. Some research suggests that anti-inflammatory (Advil, Motrin, others) and naproxen (Aleve, others) can interfere with bone healing.

Therapy: To reduce the weight-bearing force on the feet until healing occurs, you may need to wear a cast boot or walking brace or even use crutches. In severe cases, the podiatrist may need to immobilize the affected bone using a splint or cast.

Surgery: Without treatment a stress fracture can progress to an acute fracture. If the symptoms persist, and the treatment appears not to be working, surgery may be necessary to ensure complete healing of some types of stress fractures.

It’s important to give the bone time to heal. This may take several months or even longer. In the meantime:

Rest: Stay off the affected limb as instructed by your podiatrist until you are cleared to bear normal weight.

Ice: To reduce swelling and relieve pain, your podiatrist may recommend applying ice packs to the injured area up to three or four times a day for 10 minutes at a time.

Starting physical activity should be done slowly: When your podiatrist gives the okay, slowly progress from non-weight-bearing activities – such as swimming – to your usual activities. High-impact activities, such as running, should be started slowly and gradually increase in time, frequency and distance.

Simple steps can help you prevent stress fractures.

Make changes slowly: Start any new exercise program slowly and progress gradually.

Use proper footwear: Make sure your shoes fit well and are appropriate for your activity. If you have flat feet, ask your doctor about arch supports for your shoes. Insoles can provide the support and help realign the joints.

Cross-train: Add low-impact activities to your exercise program to avoid repeated stress to a particular part of your body.

Get proper nutrition: To keep your bones strong, make sure your diet includes plenty of calcium and other nutrients, especially fruits and vegetables. Exercise and taking calcium and vitamin D may also help to build stronger bones.

• For more information on foot conditions, visit www.apma.org, healthcentral.com, or email us at foothealth242@gmail.com. To see a podiatrist, visit Bahamas Foot Centre, Rosetta Street, or telephone 325-2996 for an appointment at Bahamas Surgical Associates Centre, Hilltop Medical, or call 394-5820 for an appointment. You can also visit Lucayan Medical Centre in Freeport, Grand Bahama, or telephone 373-7400 for an appointment.

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