Stress fractures are small, incomplete fractures (breaks) in bones that result from repeated stress rather than a distinct injury.
(See also Overview of Sports Injuries.)
Pain occurs with weight-bearing and worsens gradually.
X-rays or a bone scan is done.
The fractured part should not bear weight for at least 6 to 12 weeks.
Stress fractures develop when repetitive weight-bearing exceeds the ability of the supporting muscles and tendons to absorb the stress and cushion the bones. Stress fractures can involve the thighbone, pelvis, or shin. More than half of all stress fractures involve the lower leg, most often the bones of the midfoot (metatarsals).
Stress fractures do not result from a distinct injury (for example, a fall or a blow) but occur after repeated stress and overuse. Stress fractures of the metatarsal bones (march fractures) usually occur in runners who too quickly change the intensity or length of workouts and in poorly conditioned people who walk long distances carrying a load (for example, newly recruited soldiers). Other risk factors include a high foot arch, shoes with inadequate shock-absorbing qualities, and thinning bones (osteoporosis).
Women and girls who exercise strenuously and do not eat an adequate diet (for example, some long distance runners and some athletes in sports that emphasize appearance) may be at risk of stress fractures. They may stop having menstrual periods (amenorrhea) and develop osteoporosis. This condition is known as the female athlete triad (amenorrhea, disordered eating habits, and osteoporosis).
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Symptoms of Foot Stress Fractures
With metatarsal stress fractures, forefoot pain most often occurs after a long or intense workout, and then disappears shortly after stopping exercise. With subsequent exercise, onset of pain is earlier and may become so severe that it prevents exercise and persists even when not bearing weight. During physical examination, the foot may show signs of acute inflammation, or the pain can be reproduced by applying pressure to or squeezing the foot.
People who have persistent deep groin or thigh pain with weight bearing must be evaluated for a femur stress fracture near the hip joint.
Diagnosis of Foot Stress Fractures
X-rays
Standard x-rays are usually done but may be normal until about 2 to 3 weeks after the injury, when x-rays show that the bone is healing from the fracture. Earlier diagnosis is often possible by doing a bone scan or magnetic resonance imaging (MRI). Women who have stress fractures should talk with their doctors about whether they should be tested for osteoporosis. Women with stress fractures of the pelvis or femur near the hip may have undiagnosed osteopenia, which may require additional testing.
What Is a Stress Fracture?
Stress fractures are small cracks in a bone caused by repetitive impact. They commonly occur in the bones of the midfoot—the metatarsals. |
Treatment of Foot Stress Fractures
Rest
Treatment includes reduction of weight bearing on the involved foot or leg. For a while, the person uses crutches and a wooden shoe or other commercially available supportive shoe or boot. Casts are sometimes needed. Healing can take up to 12 weeks. As with other injuries, people can maintain aerobic fitness by doing non-weight–bearing exercises (for example, swimming) until recovery is complete. People with femur stress fractures near the hip should be seen by a specialist.
