A stress fracture is a small crack in a bone. These fractures most often result from overuse and can occur with an increase in activity. Stress fractures most commonly occur in the weightbearing bones of the legs. When a bone is subjected to a new stress, such as a new exercise routine, it may not be prepared for the increased workload, and as a result, may develop a stress fracture.
The symptoms of stress fractures vary widely. The most common complaint is pain. The pain may develop gradually and often is relieved by rest. Pain usually becomes more intense with physical activity and can be associated with swelling. It is rare to see bruising or discoloration.
Overuse is the most common cause of a stress fracture. An increase in exercise, athletics, job duties, or even a change in shoes can cause a stress fracture. Other risk factors include repetitive and high-impact activities, such as running, gymnastics, and dance. Osteoporosis also may increase the risk of a stress fracture. Weaker bones may be more susceptible to changes in activity. Any bone of the foot can develop a stress fracture.
After learning your medical history, your foot and ankle orthopedic surgeon will examine your foot for areas of tenderness and take X-rays. A stress fracture typically is painful directly over the affected bone. If the X-rays are normal, but there is still a high suspicion for a stress fracture based on your history and exam, your surgeon may order additional imaging such as a CT scan, bone scan, or MRI.
Since stress fractures most often occur as a result of overuse, initial treatment includes stopping the activity that brought on the fracture. A period of rest typically is needed. If a low impact type of exercise such as biking does not recreate the pain, it may be permitted.
If pain continues with rest from activity, your surgeon may recommend additional treatment. This can include wearing a stiff-soled shoe, a rigid insert/orthotic, or a walking boot. In some cases, your doctor may recommend limited weightbearing with crutches, or even a cast. Calcium and vitamin D supplements may be prescribed to supplement bone health.
Most stress fractures will heal with conservative treatment. If the bone fails to heal, surgery may be necessary. Surgery often involves placing metal plates and screws to secure the bone. Alternatively, your surgeon may inject a bone substitute through a small incision.
Risks and Complications
The most common complication that occurs with a stress fracture involves the bone not healing, called a nonunion. Other complications include malunion, in which the bone heals but in an abnormal position, or recurrent fractures. Recurrent fractures occur more often if the patient has osteoporosis. Patients with osteoporosis should speak with their doctor regarding treatment options.
How can I prevent stress fractures?
There are precautions you can take to reduce your risk of stress fractures:
- Start slowly when beginning an exercise program. You should walk and stretch to warm up before progressing to running.
- Make sure your shoes fit properly and have adequate cushioning.
- Make sure you take the time to cool down properly after exercise.
- If you notice discomfort, avoid higher-impact exercise and activity.