WHAT IS A STRESS FRACTURE?

A stress fracture is an incomplete crack in a bone. Stress fractures are caused by repeated stress or repetitive activity over a period, weakening the bone.

Stress fractures are common in runners and athletes who participate in soccer, basketball and people who change their activities such as by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture.

LOCATION
The most common sites of stress fractures are in the second and third metatarsal bones. They can also occur in other bones as well such as:
• Calcaneus (heel)
• Navicular (mid-foot)
• Tibia (shin)
• Neck of Femur (hip)

SYMPTOMS
• Pain on weightbearing
• Reduction of pain during rest
• Swelling at the fracture site
• Bruising may occur
• Warm to touch
• Erythema
• Pain on direct palpation or squeezing of the foot.

CAUSES
• Ankle joint stiffness
• Change in surface, such as a tennis player going from a grass court to a hard court.
• Inappropriate footwear (especially high heels or tight shoes)
• Inappropriate or excessive training
• Leg length discrepancies
• Muscle weakness (particularly of the gluteals, quadriceps, calf and core stabilisers)
• Poor biomechanics
• Poor flexibility (particularly of the calf muscles)
• Weak bone i.e. osteoporosis
• Weight gain

DIAGNOSIS
At Mint Foot Care Podiatry, we diagnose this condition by taking a comprehensive history, physical examination and prescribing diagnostic imaging. Stress fractures usually do not appear on plain X-rays until 4-5 weeks after symptoms appear. The podiatrist may prescribe diagnostic imaging such as a bone scan or MRI.

TREATMENT
Treatment varies depending upon the location of the stress fracture and its severity. The majority of stress fractures are treated non-surgically. At Mint Foot Care a combination of treatment options will be prescribed such as RICE (rest, ice, compression and elevation) and wearing a Controlled Ankle Motion (CAM) walker or moon boot to off load weight, immobilise the foot and ankle and help promote healing. Stress fractures usually take 6-8 weeks to heal and the CAM walker must be worn for this period during weightbearing. It can be removed for bathing and sleep.

Once the foot has healed a biomechanical assessment and video gait analysis can be performed to correct any underlying biomechanical issues.