Stress Fracture or Stress Injury

What is a stress fracture?

A stress fracture (sometimes called a “stress injury” or “stress reaction” if the bone has not actually cracked or fractured yet) is a common condition where a bone becomes weakened to the point of either almost breaking (stress injury/reaction) or actually breaking (stress fracture).  The word “stress” is used because there has not been any one incident or traumatic eveny that led to the fracture, but rather too much repeated force or “stress” on the bone such that it starts to get weak and painful and can eventually crack.  This would be different from a “traumatic fracture” where the broken bone is a result of a fall or isolated injury.

Symptoms of a Stress Fracture

Stress fractures of the foot occur most frequently in a metatarsal bone which is one of the long skinny bones on the top of the foot leading down to the toes, but they can occur in almost any bone of the foot.  Symptoms of a stress fracture will be pain with pressure over the bone,  pain with weight or pressure on the foot through the same area, and if the bone actually begins to break there is frequently swelling and sometimes subtle visable bruising.

Diagnosing a Sress Fracture

The diagnosis of a stress fracture is a good possibility if an exam demonstrates significant pain or tenderness directly over a metatarsal of the foot.  X-rays are usually recommended to further investigate.

AP x-ray of a 3rd metatarsal stress fractureImaging:  x-rays are typically used in the initial workup of a possible stress fracture.   Sometimes a small crack in the bone can be visualized.  Sometimes there is a subtle white fuzziness around the bone which indicates a stress fracture has occurred and new bone is forming around the fracture to stabilize it and heal it. (see photo to the left and notice subtle white fuzziness in the 3rd metatarsal)

Not infrequently the x-rays will show no abnormalities and look normal.  If so it is assumed that either there is only a stress “reaction” but no “fracture” yet, or the diagnosis may just be wrong.  When x-rays show nothing wrong and the exam is very convincing for a stress fracture I typically recommend the “suspected stress reaction” be treated with reduced walking or immobilized using a cam walker.  Somtimes I will order an MRI to help with the diagnosis.

Treatment of Stress Fracture or Stress Injury

Teatment of a stress fracture involves 4-6 weeks, sometimes more, reduced activity and wearing a cam walker to take the “stress” off the foot.   A. Cam Walker that fits appropriately will usually allow the patient to walk but still remove enough pressure from the foot to allow healing.  Smokers beware, smoking and bone healing do not get along very well.   If you smoke, you may be at increased risk for developing a fracture that takes a long time to heal, or it may not heal at all.  Most people who experience stress fractures can return to regular activity within 6-8 weeks of using the boot.   Every individual is different , some take longer, some heal more quickly and some fractures may require completely removing weight from off the foot with crutches or a walker.  Once recovered, sometimes an orthotic or shoe insert and some routine stretching can help to try to prevent new fractures from occuring.

Additional workup of stress fracture

Sometimes other medical conditions can lead to increased risk of stress fracture.  Poor bone density and being overweight are probably the most common causes but low vitamin D levels or other metabolic problems can also play a roll.  They occur more often in women than men and typically in post menapausal years as bone density often diminishes.  If you experience a stress fracture it is recommended that you talk with your primary care doctor to determine if furthur workup is needed.

If you have been noticing pain in the top of the foot along the metatarsal bones, swelling, or difficulty putting pressure on the foot you should not put this off.  Give us a call and make an appointment.  The sooner the fracture is identified and treated, the sooner you can get back to yourself.