Stress Fractures of the Foot and Ankle
A stress fracture is a small crack in a bone, or severe bruising within a bone. Most stress fractures are caused by overuse and repetitive activity. They are very common in runners and athletes. Stress fractures usually occur when people change their activities. Trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors) are great examples. If osteoporosis or other disease has weakened the bones, everyday activities can result in a stress fracture. Because of the repetitive forces they must absorb during activities like walking, running, and jumping, the weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures. The key to recovering from a stress fracture in the foot or ankle is refraining from all high impact activities for a while and allowing the fracture to heal. The healing process will be delayed if you return to your activities too soon. You also place yourself at risk for a complete fracture. Should that happen, it will take much longer to recover.
Description
Stress fractures occur most often in the second and third metatarsals in the foot, which are thinner (and often longer) than the adjacent first metatarsal. This is the area of greatest impact on your foot as you push off when you walk or run. Stress fractures are also common in the calcaneus (heel); fibula (the outer bone of the lower leg and ankle); talus (a small bone in the ankle joint); and the navicular (a bone on the top of the midfoot). Many stress fractures are overuse injuries and occur over time when repetitive forces result in microscopic damage to the bone. The repetitive force that causes a stress fracture is not great enough to cause an acute fracture. Overuse stress fractures occur when an athletic movement is repeated so often, weight-bearing bones and supporting muscles do not have enough time to heal between exercise sessions. Bone is in a process called remodeling. Remodeling allows new bone to develop and replace older bone. If an athlete's activity is too great, the breakdown of older bone occurs rapidly and it outpaces the body's ability to repair and replace it. Because of that, the bone weakens and becomes vulnerable to stress fractures.
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. Until you can see your 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, over-the-counter medications such as ibuprofen or naproxen can help relieve pain and reduce swelling.
Doctor Examination
Your doctor will look for areas of tenderness by applying gentle pressure directly to the injured bone. The key to diagnosing a stress fracture is usually the patient's report of pain in response to this pressure. Pain from a stress fracture is not generalized over the whole foot, but is typically limited to the area directly over the injured bone. Your doctor may order x-rays to help confirm the diagnosis. 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 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 becomes visible.
Treatments:
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 plan will help you return to normal activities faster and prevent further damage to the bone.
The majority of stress fractures are treated non-surgically. Your doctor may also recommend that you use crutches to keep weight off your foot until the pain subsides. Other recommendations for non-surgical treatment may include:
- Modified activities. It typically takes from 6 to 8 weeks for a stress fracture to heal. During that time, you�€™ll want to 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 without a doctor�€™s recommendation.
- Protective footwear. To reduce stress on your foot and leg, your doctor may recommend wearing 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.
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. After the stress fracture has healed and you are pain free, your doctor will allow a gradual return to activity. As your fitness level improves, you will 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.