The Causes and Treatment of Foot and Ankle Stress Fractures

The bones of the legs and feet are the most common locations of stress fractures. The bones that are most often affected include the lower parts of the tibia and fibula bones of the leg and the second and third metatarsal bones of the foot.

A stress fracture can develop after repeated excess pressure or loading on a bone. It differs from a typical broken bone caused by a sudden injury in that a stress fracture develops in response to repeated stress on the bone that wouldn't be expected to break the bone if it occurred just once.

These types of bone fractures are often associated with running and other athletic activities, especially when there's been a recent increase in activity and pressure on the bone.

Stress fracture location is sometimes linked to a particular sport or activity.

• Runners have a higher risk of tibial stress fractures.
• Activities that involve a lot of stress on the forefoot, such as dancing or track and field, bring an increased risk of stress fractures of the metatarsals or navicular bone of the foot.

Symptoms and Diagnosis

A stress fracture can cause pain that is brought on or made worse with weight-bearing. You may also feel pain with direct pressure on the bone.

If left untreated, the pain will usually worsen, and continued stress on the bone may cause a stable hairline fracture to develop into a more unstable fracture. This is why it's important to decrease weight-bearing activities and seek medical treatment.

A developing stress fracture may not always show up on an X-ray, which can make diagnosis difficult. It is not uncommon for initial X-rays of bone to show no fracture, while a follow-up X-ray—days or even weeks later—may reveal that a stress fracture has in fact occurred.

If an initial X-ray is normal, but there is a high likelihood of a stress fracture, medical providers will often use other diagnostic methods, such as a CT scan or MRI.

Treatment

Treatment for a suspected or confirmed stress fracture will involve rest and a change in athletic activity that's sufficient enough to allow for healing. Immobilization in a walking cast or hard-soled shoe may be prescribed for a few weeks, depending on the degree of fracture and symptoms.

Follow-up X-rays or other diagnostic tests are used to evaluate bone healing.

Risk Factors

Stress fractures are most often associated with athletic activity, but other factors increase the risk as well. Osteoporosis or any condition that causes a decreased bone mass will increase the risk of a stress fracture, including:

• Post-menopausal women and women who have irregular menstrual cycles, resulting in amenorrhea
• Tobacco use
• Moderate to heavy alcohol use
• Lower body mass
• Medications such as corticosteroids and DMPA (Depo-Provera)
• Inadequate levels of calcium and vitamin D
• Abnormalities of foot structure or foot biomechanics, such as a high-arched or flat foot