Stress Fractures

What is a Stress Fracture?
A stress fracture is a small crack or severe bruising within a bone, often caused by repetitive force or overuse. Unlike acute fractures that result from a single traumatic event, stress fractures develop gradually over time due to repeated stress on a bone. They are most common in the weight-bearing bones of the lower leg and foot, such as the metatarsals, tibia, and navicular bones. Stress fractures are particularly common among athletes, especially runners and dancers, but can affect anyone who engages in repetitive, high-impact activities.

Symptoms of a Stress Fracture
Stress fractures typically present with localised pain that develops gradually and worsens with activity. Symptoms can include

• Localised Pain: A sharp or aching pain at a specific point on the bone, often described as "pinpoint" pain, which intensifies with weight-bearing activities
• Swelling and Tenderness: Mild to moderate swelling may occur around the site of the fracture, along with tenderness when pressing on the affected area.
• Pain that Improves with Rest: The pain generally subsides with rest and returns when resuming activity.
• Visible Bruising or Redness: In some cases, bruising or redness may appear over the site of the stress fracture.
• Worsening Pain Over Time: Without appropriate management, the pain may become more severe and persist even at rest or with minimal activity.

Why Do Stress Fractures Occur?
Stress fractures occur when repetitive forces exerted on a bone exceed its ability to repair itself. Factors that contribute to the development of stress fractures include

• Overuse and Repetitive Activities: Activities that involve repetitive impact on bones, such as running, jumping, or dancing, can overload the bone The constant strain prevents the bone from healing naturally.
• Sudden Increase in Physical Activity: A rapid escalation in the intensity, duration, or frequency of exercise, such as when a runner increases mileage too quickly, can lead to stress fractures.
• Improper Footwear: Wearing shoes that lack adequate support, cushioning, or proper fit can increase stress on certain bones, particularly in the feet.
• Bone Density Issues: Conditions such as osteoporosis, low bone mineral density, or nutritional deficiencies (like insufficient calcium or vitamin D) can weaken bones, making them more susceptible to fractures.
• Foot Biomechanics: Abnormal foot mechanics, such as high arches or flat feet, can alter the distribution of forces during movement, increasing the risk of stress fractures.
• Gender and Hormonal Factors: Women, especially those with irregular menstrual cycles or conditions like the female athlete triad (disordered eating, amenorrhea, and osteoporosis), are at higher risk due to potential hormonal imbalances affecting bone density.

Common Management Options for Stress Fractures
The primary goal in managing a stress fracture is to allow the bone to heal while minimising pain and preventing further damage. Management strategies include

• Rest and Activity Modification: Ceasing the activity that caused the fracture is essential for recovery. Non-weight-bearing activities, such as swimming or cycling, can help maintain fitness levels without putting stress on the fracture.
• Protective Footwear or Braces: Wearing supportive footwear, such as stiff-soled shoes or orthopaedic walking boots, can reduce stress on the affected bone and provide stability. In severe cases, crutches may be necessary to completely offload the weight from the bone.
• Gradual Return to Activity: Once the bone has sufficiently healed, a gradual return to physical activity is This involves slowly increasing the intensity and duration of exercise while monitoring for any signs of pain.
• Physical Therapy: A Podiatrist or physical therapist can provide exercises to strengthen the muscles around the injured area, improve flexibility, and enhance overall body mechanics to prevent future fractures.
• Orthotic Devices: Custom orthotic devices may be prescribed to correct abnormal foot mechanics and provide better shock absorption during activities.

Why See a Podiatrist for Stress Fractures? 
Seeing a podiatrist is essential for accurately diagnosing and managing stress fractures. Podiatrists have specialised knowledge in foot and lower limb biomechanics and can perform thorough evaluations to identify risk factors that may have contributed to the injury. They can utilise imaging techniques like X-rays or MRI to confirm a stress fracture diagnosis and determine its severity. A podiatrist can develop a tailored treatment plan that includes proper footwear recommendations, orthotic devices, rehabilitation exercises, and a safe return-to-activity strategy. Early intervention and expert guidance from a podiatrist can prevent the stress fracture from progressing to a complete fracture and reduce the risk of recurrence.