The fall season is a time where many of us are outside hiking, running or enjoying other exercise. With this increased exercise, problems may develop. Any time there is a sudden onset of pain and swelling of the foot or ankle without any recent known injury or trauma a stress fracture has to be considered– a stress fracture is a small crack in the bone.
Stress fractures are very common in the weight-bearing bones of the lower extremity with the 2nd metatarsal bone the most common. Repetitive stress of these bones being the causative factor.
Bone remodeling is the process where mature bone is removed and replaced by new bone. This is a process occurring continually throughout our lives. If this process is not in balance a stress fracture can occur.
A rapid increase in activity (a new running or walking program, training for a race, increase in exercise frequency), a job requiring standing and walking (nurses, teachers, factory workers), elderly patients whose bone strength has diminished are all common causes of stress fractures. Improper shoe wear may also play a role in the development of a stress fracture.
Symptoms and Diagnosis
Pinpoint pain and swelling that increase with activity and as the day progress are often the initial complaint. Stress fractures are usually diagnosed with x-rays. Stress fracture cannot be seen on x-ray until the bone begins to heal itself by forming new bone. This is usually takes 2 – 3 weeks after the onset of pain. Infrequently, a bone scan or MRI is needed to help with the diagnosis.
Treatment and Prevention
Stress fractures usually heal in 6 – 8 weeks provided proper care is given. Most of the time a walking boot combined with reduced activity will lead to uneventful healing. Continued high activity can lead to a complete fracture of the bone and nonunion.
In most cases once you have healed from a stress fracture normal activity may resume. Wearing a good supportive shoe with adequate shock absorption should help in preventing this from happening again. A gradual increase in activity when starting or resuming exercise is important in prevention as well.
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