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Recovery Guide: Stress Fracture

What Is It?

Stress fractures are typically non-displaced breaks in bone that occur through overuse of physical activity. Fractures are brought on by high energy and low energy injuries. High energy breaks are termed traumatic fractures and occur through a significant amount of force. Stress fractures are low energy breaks and occur through rapid exposure to low energy forces. Thus, a break can form when the same site is exposed over and over again to the same amounts of force. These types of fractures are common in athletes who increase the intensity, severity, and frequency of their activity (such as running). In a nut shell, stress fractures are an injury of overuse. Sometimes transitioning to higher level activities too soon or running on improper terrain can also lead to a stress fracture. This is one of the reasons why healthcare and exercise specialists recommend progressing steadily to more active workout routines and running on soft terrain like a treadmill. Though stress fractures are typically attributed to overuse, other underlying medical conditions can contribute. Conditions that weaken the bone such as osteoporosis or malnutrition can make individuals more prone to obtaining a stress fracture.

stressframe

Stress fractures in the foot and ankle are common since we are on our feet all the time. The metatarsals (second and third metatarsals most commonly), the calcaneus (heel bone), and navicular (one of the main bones of the midfoot that connect to the ankle bone) are the most common bones that obtain a stress fracture. Stress fractures in the tibia (long bone of the lower leg), fibula (smaller long bone of the leg that runs along the tibia), and talus (ankle bone) also run the risk of acquiring a stress fracture. It could be difficult to tell if you have a stress fracture since signs can be subtle. Pain can rise with activity, but dissipate with rest. Pain levels can also increase over time depending on how active and aggressive individuals are in their daily routines. Swelling, bruising and some tenderness may also appear. The only real way to rule out a stress fracture is to visit a doctor and have an x-ray or MRI taken. MRI’s are stronger then x-rays, but are often not needed to confirm a diagnosis.

Treatment Options

Fortunately, most stress fractures do not require surgery and can heal on their own. However, recovery times depend on the location of the breaks since some bones can take longer to heal then others. The goal is to reduce activity and to protect the break. Doctor’s will most likely prescribe protective footwear such as an orthotic boot, shoe or a brace, and occasionally require a knee scooter. The length of wearing such footwear can take anywhere from 4-6 weeks. Your level of activity will also be decreased. Runners for example will most likely need to reduce activity to biking or another workout that does require placing pressure on the foot. A stress fracture can take about 1 to 2 months to heal so you would most likely be advised not to return to your typical active routine until at least after two months. Again, this all depends on the bone broken. The navicular, talus, and fifth metatarsal bones take the longest to heal so patients with these types of stress fractures may have a longer recovery period.

Prognosis

It is important to listen to your doctor and only progress back to active duty once the stress fracture is fully healed. Even after a stress fracture is healed it’s important to make a gradual progression in activity to prevent the risk of re-fracture. Low impact exercises are key as well as comfortable and supportive footwear. If surgery is needed, it’s typically because the break has not healed after conservative methods. A surgeon will most likely have to fasten the bones together using internal fixation such as screws, plate or nails.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

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