What are Stress Fractures?

Sometimes known as "March Fractures", as they are a common occurrence among those serving in the military due to frequent running, jumping and other high impact activities.

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Overview

A stress fracture is a term applied to bone injuries in the foot that are tiny cracks in the bone. It is commonly caused by repetitive stress on the foot, typically caused by activities such as jumping or running long distances. Stress fractures are small cracks or hairline fractures in bones, typically caused by repetitive stress or overuse. Stress fractures can cause intensifying pain, often described as a sharp, stabbing sensation that intensifies with every step. The pain is typically located in the affected bone, such as the metatarsal bones in the foot, and worsens significantly when weight is applied, making standing or walking almost unbearable.

The difference between stress fractures and regular fractures are that stress fractures are caused by repetitive stress rather than a single traumatic event. They can occur in multiple areas of the lower limbs, with the second and third metatarsal, the heel, and fibula being some of the common areas of injury.

Causes

The most common cause of stress fractures is a sudden increase in intensity or frequency of activity or doing too much physical activity within a short period of time. Our bones are constantly renewing themselves through a process called remodeling, when there is insufficient rest or too much activity, the stress created by these activities can wear out the bones faster than our bodies can repair and replace them. This causes the bone to weaken and vulnerable to stress fractures.

Research has also suggested that women are more likely to develop stress fractures. One increasingly common cause of these injuries is a complex condition called "Female Athlete Triad" which is a combination of:

  • Energy deficiency
  • Bone loss
  • Menstrual dysfunction

This can directly impact their musculoskeletal development and growth, as well as their menstrual cycles. The combination of these factors can be an indicator of stress fractures, so these issues can be medically relevant for achieving an accurate diagnosis.

Who are those at risk?

  • Individuals starting a new workout program
  • Wearing worn-out footwear
  • Biomechanical issues such as hypermobility
  • Bone insufficiency conditions such as Osteoporosis
  • Vitamin D insufficiency

Research has also suggested that women are more likely to develop stress fractures. One increasingly common cause of these injuries is a complex condition called "Female Athlete Triad" which is a combination of:

  • Energy deficiency
  • Bone loss
  • Menstrual dysfunction

This can directly impact their musculoskeletal development and growth, as well as their menstrual cycles. The combination of these factors can be an indicator of stress fractures, so these issues can be medically relevant for achieving an accurate diagnosis.

Patients who are undertaking extreme diets or have Vitamin D insufficiency are at a greater risk of stress fractures as the bone density is often reduced.

Women suffering from the Female Athlete Triad are particularly susceptible and should take care to see a podiatrist should there be any discomfort as their bodies are more susceptible to these injuries.

Stress fractures are commonly caused by a sudden increase in an individual's physical activity level. Often patients who start a new workout program or begin training for events such as marathons or distance running are at risk of developing stress fractures.

Footwear that is flimsy or worn out, unsupportive, or an underlying biomechanical condition such as hypermobility or a tendonitis can reduce your foots ability to absorb the repetitive forces as your foot strikes the ground, consequently causing stress fractures.

Stress fractures can cause pain which may intensify and make weight bearing activities unbearable, such as walking, running or standing.

How is a stress fracture diagnosed?

Diagnosing stress fractures will involve a physical examination where your podiatrist or healthcare provider will identify the areas of pain. They may use diagnostic ultrasound imaging to asses the internal structures of your body for any damage and swelling around the bone that is commonly associated with a suspected stress fracture.

In some cases, your podiatrist may request for X-ray test to provide detailed images of the bone and check for any bone callus or breaks in the cortex of the bone as this may also be suggestive of stress fracture.

A comprehensive review of your medical history will assist your clinician in identifying any potential risk factors by exploring lifestyle choices, past medical conditions and any other related information.


How can a Podiatrist help with Stress Fractures?

The aim of podiatric intervention for stress fracture is to allow your body to heal and return to normal activity as soon as possible. While stress fractures are often caused over time, they can also be acute or chronic depending on when injury was sustained. In the first 12-14 Hours after a stress fracture, it is advisable to avoid bearing weight on the affected limb, elevate the foot and apply cold compress.

Bone healing usually takes around 6 – 12 weeks in adults, while children are able to heal slightly faster. Conservative therapies such as shockwave therapy or SIS can speed up the recovery process by stimulating the body’s natural healing abilities and encouraging blood flow.

For more severe cases, you may also be prescribed you a custom cast or boot to offload and reduce any weight through the area.

The long-term goal for managing a stress fracture is to prevent recurring injuries. This may be achieved through the use of custom foot orthotics to manage and redistribute pressure, provide support, preventing overloading to the affected area which is typically how the injury recurs.

Heeding your podiatrist’s advice is essential for full recovery and preventing future injuries.

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Common Symptoms

The pain usually begins at the same spot
Swelling
Tenderness
Bruising

How It Looks Like

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Went to check on a sharp pain after rolling my left foot. Millicent was great at quickly diagnosing the fracture(stress fracture). Quickly recommended a boot to offload the weight put on my left foot, plus a list with things to do to help the healing process. Just had the check-up for the healing of the foot. All went good! Great feedback all the times, always accessible via whatsapp too for any questions regarding the injury. Highly recommend this place. Great service, staff, affordable prices too. Thank you guys so much again. :)

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