Stress fractures are common in the foot and ankle. A stress fracture represents a chronic injury where there’s an imbalance between the loads sustained by the bone and the ability of the body to heal the injury. There are two main causes of stress fractures: overuse injury or bone metabolic issues.
Overuse injuries in the foot and ankle are usually related to running or sprinting and a sharp increase in distance. Even a sudden increase in walking can cause a stress fracture, such as a vacation to Europe or Disneyland, which may significantly increase daily mileage
Metabolic bone disorders such as osteopenia or osteoporosis, Vitamin D deficiency, use of oral steroids, and other systemic bone issues may lead to unusual weakness in the bone that makes it susceptible to fracture of the foot even under normal stress.
The first step in diagnosis is appropriate imaging (weight-bearing x-rays of the foot and ankle) and a thorough physical examination. There is generally warmth and swelling over the area of the fracture. If there is suspicion for a stress fracture, an MRI will be ordered.
Each different bone has a different approach to treatment. Some are amenable to nonoperative treatment and others are not.
A camboot to fully immobilize the foot and ankle will be necessary in the event of a stress fracture. Fractures take 6-12 weeks to heal
Vitamin D levels will be tested and Vitamin D will be supplemented as necessary. Usually, 2000-5000iu of Vitamin D3 is recommended.
NSAIDs should be taken around the clock for two to three weeks for anti-inflammatory dosing. Speak to your physician if you have concerns about whether anti-inflammatories are safe for you.
Only use ice if you have no numbness in your feet. If you have neuropathy, ice application may not be safe. Always protect the skin with a tea towel. Ice for up to twenty minutes at a time, and wait an hour if you are going to repeat the ice application.
Physical therapy is not expected to change heal a stress fracture. It works to improve strength and balance, and stretch the muscles that tighten over time due to the injury after the fracture has healed. A physical therapist can also help to reintroduce the athlete to impact activities in a safe manner
The surgery required for some stress fractures will be discussed in detail if you are a candidate. This is relatively uncommon.