Stress Fractures — a Common Source of Foot Pain

Robert Hume, DPM, FACFAS
Podiatric Medicine
Chippewa Valley Orthopedics & Sports Medicine
Eau Claire

The foot is made up of 26 bones and a painful problem affecting them is a stress fracture. Stress fractures differ from the type of fracture most people are familiar with, the common traumatic fracture that most of us suffer at some point in our lives associated with acute injury. In most cases, a traumatic fracture leaves the involved bone in two or more pieces. In contrast, a stress fracture is actually a tiny hairline fracture created by repetitive stress. The area of the bone involved becomes painful, but the architecture of the bone remains intact. It occurs without any recognizable acute cause because it occurs after days or weeks of overuse. It has been commonly called a “march fracture” because of its appearance in new recruits in boot camp who are subjected to marching long distances and often as part of their basic training. Sedentary recruits are much more likely to develop these fractures compared to their more active counterparts. People of all ages who are new to exercise and do too much, too soon, are likely to suffer this injury.

“An injury to one part of the foot may predispose the part of the foot that receives the increased use to sustain a stress fracture.”

The repetitive stress is in the form of increased frequency, intensity and duration. They can also be caused by poor or worn-out shoes, abnormal foot structure or a change in the weight bearing surface; switching from running on grass to a route that involves mainly cement for example. An injury to one part of the foot may predispose the part of the foot that receives the increased use to sustain a stress fracture. People with medial heel spur pain generally shift their weight laterally putting the structures on the outside of the foot at risk. People suffering from bunions may do the same thing. Eating disorders and osteoporosis increase the risk because of their negative effect on bone strength.

Symptoms may vary, but pain is generally gradual in onset, increases with weight bearing and is relieved by rest. Pain is present while just performing the activities of normal daily living. The fracture site is tender to the touch, but this occurs without swelling or bruising. Any bone in the foot can be involved, but forefoot bones (metatarsals) are the most common. These are the long bones that make up the forefoot.

The diagnosis is considered when pressure applied to a specific bone causes pain. Plain x-rays may or may not reveal the fracture. Treatment involves some form of immobilization of the foot, usually a protective shoe, sometimes even a cast. If initial treatment is unsuccessful, a bone scan or an MRI may be necessary to confirm the diagnosis. If the pain is ignored and left untreated, these fractures can proceed to a total fracture. This can be associated with poor alignment of the fracture fragments sometimes even requiring surgery to realign them. For that reason, ignoring the pain and continuing the activity is unwise. Six to eight weeks is most often the amount of time necessary for healing to occur. A gradual resumption of activities is also necessary to avoid re-injury. Runners especially should avoid increasing distances too fast. Cross training is also important to give certain parts a rest. Strength training has been shown to have a positive impact in avoiding these injuries. Quadriceps strength is especially important in runners.

So if you find yourself with this type of nagging injury, seek professional help to avoid further complications. Remember that when beginning a new exercise, or increasing the level or duration of your normal workout, to do so on a gradual basis. Give your body a chance to respond to a more vigorous workout so you can avoid being sidelined by injury. Change your running shoes every 350 miles so they retain good shock absorbing ability. Most importantly, begin new activities slowly with calculated increases in intensity and duration. Don’t let an avoidable injury sideline you.

Dr. Hume – Chippewa Valley Orthopedics & Sports Medicine
For information or to schedule an appointment:
715.832.1400 | 800.322.1747 | cvosm.com
Dr. Hume sees patients in Eau Claire and Chippewa Falls.