Stress Fracture

A stress fracture is an overuse injury that occurs when muscles become exhausted. The muscles are no longer able to absorb or decrease the shock of repetitive impacts. When this continues on a chronic basis, the muscles transfer the stress to the bones. This can result in small cracks or fractures.

The most common sites of stress fractures are the second and third metatarsals in the foot. Stress fractures are also common in the heel, the outer bone of the lower leg and the navicular, a bone on the top of the midfoot. These areas are the most susceptible to stress fractures because of their anatomical functions and location in the body.

Stress Fracture Symptoms
Stress fractures can initially be noticed as pain that develops gradually, increases with weight bearing or impact activity, and decreases with rest. Pain that becomes more severe and occurs during normal, daily activities with swelling on the top of the foot or the outside of the ankle, is also very common. Tenderness and bruising at the site of the fracture are possible.

Stress Fracture Diagnosis
Diagnosis will depend on the physician’s physical examination and diagnostic testing. Imaging tests may help your doctor make a diagnosis. Stress fractures are difficult to see on regular X-rays until they have actually started to heal. Your doctor may recommend a bone scan or an MRI, which are more sensitive than X-rays. These are best for identifying stress fractures early.

Non-surgical Treatment of Stress Fracture
Treatment will vary depending on the location of the stress fracture and how severe it is. The goal of any treatment is to help you return safely to all activities. Following a doctor's treatment plan will restore your abilities faster and help prevent further problems in the future.

Gwinnett Medical Center–Duluth recommends taking a break from the activity that caused the stress fracture. It typically takes six to eight weeks for a stress fracture to heal. During that time, switch to lower impact activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. Always consult with your physician before any activity on the involved foot or ankle.

To reduce stress on your foot and leg, your doctor may recommend wearing protective footwear. This may be a stiff-soled shoe, a wooden-soled sandal or a removable short-leg fracture brace shoe.

Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the anklebones take longer to heal because they are weight bearing. Your doctor may apply a cast to your foot to keep the bones in a predetermined position to remove any potential stress on the involved leg. Casts are a type of external fixation. To keep weight off your foot and leg, your doctor may recommend the use of crutches until the bone heals.

Surgical Treatment of Stress Fracture
Some stress fractures require surgery to heal correctly. In most cases, this involves supporting the bones by inserting a type of fastener in the bone. This is called internal fixation. Pins, screws and/or plates are most often used to hold small bones of the foot and ankle together while healing occurs.

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