Physician Journal : Stress Fractures

A stress fracture is a tiny or incomplete crack in a bone that is often caused by overuse. Stress fractures occur most frequently in the foot and ankle, so your podiatric physician is well trained todiagnose and treat this problem.

Stress fractures may be caused by a number of factors. Overuse or strain in the foot (fatigue fracture) is one of the most common causes, while weak bones (insufficiency fracture), caused by medical conditions such as osteoporosis, can also be a factor. Medications such as steroids can lead to stress fractures, as can a sudden increase in activity levels. All of these causes can and should be evaluated by your podiatrist when you have the signs and symptoms of a stress fracture.

Those signs may include pain that increases with activity and decreases with rest, pain that increases over time, or pain that persists even at rest. Often a stress fracture will result in swelling and a spot that feels tender to the touch.

If you experience any pain during physical activity or any of the symptoms described, you should see your podiatric physician. Prompt diagnosis and treatment of a stress fracture can often prevent further injury. The doctor will ask you to describe the signs and symptoms and then physically evaluate your foot or ankle. While x-rays will most likely be used for diagnosis, often stress fractures do not appear on regular x-rays for several weeks after the symptoms begin. In some cases, the fracture may never appear on an x-ray. In those cases, the doctor may recommend other diagnostic testing such as MRIs, ultrasounds, or bone scans.

Many stress fractures can be treated with rest, ice and over-thecounter pain relievers. For most people, an appropriate period of rest will be sufficient for the bone to heal. In other cases, your podiatrist may need to immobilize the affected bone with a cast, cast boot, fracture shoe, or a splint. In the most severe cases, a pin may be surgically inserted into the bone to hold it together and promote proper healing. However, surgical intervention is the treatment of last resort.

Here are a few simple steps to prevent stress fractures:Start new exercise programs slowly and progress gradually. Work with your doctor to design a routine that fits your fitness level.Avoid sudden intensity changes in your exercise routine.Always use the proper equipment for your sport. This includes finding the best shoe for your foot type.Cross-train to avoid repetitively stressing your feet and ankles.Visit your podiatrist to have custom shoe inserts (orthotics) made to improve foot function.Eat right and make sure that you include plenty of calcium and nutrients in your diet.

Reprinted with permission from the APMA Footprints Newsletter.

Posted by Jennifer Kirchens, DPM @ 9:23 PM

August 20, 2008