Stress Fractures

What is a stress fracture?

A stress fracture is a type of break in the bone. They occur when a moderate amount of force is applied to a bone repeatedly over a period of time. This is different from an acute injury where the bone is broken by a significant amount of force, for example a car crash, or severe twisting injury.

Stress fractures are common in the foot because we continually place loads through them by standing, walking, running and exercising. Bones that are subjected to repetitive forces become fatigued or weakened. This is called a stress reaction. This increases the risk that the bone will break and if that happens, this is known as a stress fracture.

Stress fractures often occur in 2 ways:

• People with healthy bones overuse the foot with frequent repetitive motion. This often the case in athletes who participate in high-impact sports such as running, football and tennis.
• People who have weak bones from an underlying condition (such as osteoporosis) can sustain a stress fracture from fairly low impact activities.

What are the symptoms of a stress fracture?

The key symptom of a stress fracture is pain. It maybe associated with bruising or swelling. The pain is often worse with impact activities and gets better with rest. If you think you may have a stress fracture, you must stop all activities that cause pain and you should seek specialist advice from a foot and ankle surgeon.

How are stress fractures diagnosed?

Many people go to A+E or their GP with these symptoms and are referred for an X-Ray which is often normal. This is because it may take some time for the bone reaction to be seen on the X-Ray. Therefore, more specialist imaging techniques such as an MRI scan can be helpful is making the diagnosis. It can also be helpful in assessing the other bones of the foot that may become susceptible to developing a stress reaction.

How are stress fractures treated?

Most stress fractures will heal on their own if you reduce your level of activity and wear protective footwear (such as a walking boot) for a period of time. This will be discussed with you by your surgeon. Typically, you should stop all high impact activity for about 6 weeks.

Simple treatments such as keeping the foot elevated and applying ice can help with the pain and help reduce the swelling. Simple painkillers such as paracetamol can help control the pain. If at all possible, it is recommended that you avoid anti-inflammatory tablets such as ibuprofen or voltarol as there is some data to suggest that they impair bone healing.

Once the pain has gone, you can slowly return to low impact activities such as swimming or cycling. For those who want to return to high impact activities, it is important to increase your running mileage slowly. You should resist the temptation to do too much, too soon as this may cause a recurrence of your symptoms.

Will I need surgery?

Fortunately surgery is rarely required and only recommended after nonsurgical approaches are not working.

How can I prevent stress fractures?

Maintaining a healthy diet and ensuring you eat calcium rich foods and Vitamin D can help with maintaining bone density. Your surgeon will often check these levels if you have symptoms of a stress fracture.

Wear appropriate footwear. Old trainers lose their shock absorbency after 500 miles and therefore it is important that you wear shoes that are fitted for your foot shape.

Avoid smoking. Both the smoke and the nicotine in cigarettes impair bone healing and may increase the time it takes for your stress fracture to heal.

Change your training pattern. Adding in some lower impact activities such as cycling and swimming to complement your running schedule can be beneficial.

Slowly increase training loads. We can all become a little too enthusiastic when starting new activities. Slowly easing into new sports can help reduce injury and prevent a stress fracture from occurring.