Stress Fractures : Symptoms , Treatment & Prevention

Symptoms

The most common symptom of a stress fracture in the foot or ankle is pain. The pain usually develops gradually and worsens during weight-bearing activity. 

Other symptoms may include:

• Pain that diminishes during rest
• Pain that occurs and intensifies during normal, daily activities
• Swelling on the top of the foot or on the outside of the ankle
• Tenderness to touch at the site of the fracture
• Possible bruising

First Aid

See your doctor as soon as possible if you think that you have a stress fracture in your foot or ankle. Ignoring the pain can have serious consequences. The bone may break completely.

Until your appointment with the doctor, follow the RICE protocol. RICE stands for rest, ice, compression, and elevation.

• Rest. Avoid activities that put weight on your foot. If you have to bear weight for any reason, make sure you are wearing a very supportive shoe. A thick-soled cork sandal is better than a thin slipper.
• Ice. Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on your skin.
• Compression. To prevent additional swelling, lightly wrap the area in a soft bandage.
• Elevation. As often as possible, rest with your foot raised up higher than your heart.

In addition, nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen can help relieve pain and reduce swelling.

Doctor Examination

Physical Examination

Your doctor will discuss your medical history and general health. He or she will ask about your work, your activities, your diet, and what medications you are taking.It is important that your doctor is aware of your risk factors for stress fracture. If you have had a stress fracture before, your doctor may order a full medical work-up with laboratory tests to check for nutritional deficiencies such as low calcium or Vitamin D.

After discussing your symptoms and health history, your doctor will examine your foot and ankle. During the examination, he or she will look for areas of tenderness and apply gentle pressure directly to the injured bone. Often, the key to diagnosing a stress fracture is the patient's report of pain in response to this pressure. Pain from a stress fracture is typically limited to the area directly over the injured bone and is not generalized over the whole foot.

Imaging Tests

Your doctor may order imaging tests to help confirm the diagnosis.

X-rays. X-rays provide images of dense structures, such as bone. Since a stress fracture starts as a tiny crack, it is often difficult to see on a first x-ray. The fracture may not be visible until several weeks later when it has actually started to heal. After a few weeks, a type of healing bone called callus may appear around the fracture site. In many cases, this is the point at which the fracture line actually becomes visible in the bone.

Other imaging studies. If your doctor suspects a stress fracture but cannot see it on an x-ray, he or she may recommend a bone scan or a magnetic resonance imaging (MRI) scan. Although a bone scan is less specific than an MRI in showing the actual location of the stress fracture, both of these types of studies are more sensitive than x-rays and can detect stress fractures earlier.

Treatment

The goal of treatment is to relieve pain and allow the fracture to heal so that you are able to return to your activities. Following your doctor's treatment plan will help you return to activities faster and prevent further damage to the bone.

Treatment will vary depending on the location of the stress fracture and its severity. The majority of stress fractures are treated nonsurgically.

Nonsurgical Treatment

In addition to the RICE protocol and anti-inflammatory medication, your doctor may recommend that you use crutches to keep weight off your foot until the pain subsides. Other recommendations for nonsurgical treatment may include:

• Modified activities. It typically takes from 6 to 8 weeks for a stress fracture to heal. During that time, switch to activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. However, you should not resume any type of physical activity that involves your injured foot or ankle-even if it is low impact-without your doctor's recommendation.

• Protective footwear. 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.

• Casting. Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal. Your doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress on your involved leg.

Surgical Treatment

Some stress fractures require surgery to heal properly. In most cases, this involves supporting the bones by inserting a type of fastener. This is called internal fixation. Pins, screws, and/or plates are most often used to hold the small bones of the foot and ankle together during the healing process.

Recovery

In most cases, it takes from 6 to 8 weeks for a stress fracture to heal. More serious stress fractures can take longer. Although it can be hard to be sidelined with an injury, returning to activity too soon can put you at risk for larger, harder-to-heal stress fractures and an even longer down time. Reinjury could lead to chronic problems and the stress fracture might never heal properly.

Once your pain has subsided, your doctor may confirm that the stress fracture has healed by taking x-rays. A computed tomography (CT) scan can also be useful in determining healing, especially in bones where the fracture line was initially hard to see.

Once the stress fracture has healed and you are pain free, your doctor will allow a gradual return to activity. During the early phase of rehabilitation, your doctor may recommend alternating days of activity with days of rest. This gives your bone the time to grow and withstand the new demands being placed upon it. As your fitness level improves, slowly increase the frequency, duration, and intensity of your exercise.

Prevention

The following guidelines can help you prevent stress fractures in the future:

• Eat a healthy diet. A balanced diet rich in calcium and Vitamin D will help build bone strength.
• Use proper equipment. Old or worn running shoes may lose their ability to absorb shock and can lead to injury. In general, athletic shoes should have a softer insole, and a stiffer outer sole.
• Start new activity slowly. Gradually increase your time, speed, and distance. In most cases, a 10 percent increase per week is appropriate.
• Cross train. Vary your activities to help avoid overstressing one area of your body. For example, alternate a high-impact sport like running with lower-impact sports like swimming or cycling.
• Add strength training to your workout. One of the best ways to prevent early muscle fatigue and the loss of bone density that comes with aging is to incorporate strength training. Strength-training exercises use resistance methods like free weights, resistance bands, or your own body weight to build muscles and strength.
• Stop your activity if pain or swelling returns. Rest for a few days. If the pain continues, see your doctor.

Source: orthoinfo 

RIVERA FOOT & ANKLE: At Orlando H.Rivera DPM, our priority is to deliver quality care to informed patients in a comfortable and convenient setting. When you have problems with your feet, you need to turn to a podiatrist who listens and responds… an experienced doctor who knows the field and can effectively diagnose and treat your needs… a friendly physician who counsels you on the best ways to maintain and improve your health. Our physician(s) meet all these criteria. Plus, you benefit from a dedicated team of trained professionals who give you the individualized attention you deserve.

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