foot/ankle STRESS FRACTURE
DEFINITION:
- Also known as “insufficiency fracture” and “march fracture”.
- The development of a crack/defect in the bone as result of excessive stress.
- Often seen in the metatarsal bones of the foot (2nd, 3rd, and 4th in that order), but also seen in other bones of the foot and ankle. (See illustration).
MECHANISM / HOW IT OCCURS:
- Repetitive impact activities and overuse such as seen with running and gymnastics.
- Sudden increase in intensity of workout / overtraining.
- Metatarsal fractures were commonly seen in military recruits and were known as “March fractures”, a result of being required to march for extensive periods of time.
- Also seen in sedentary individuals who too aggressively begin an exercise routine.
SYMPTOMS:
- Individuals present with a complaint of pain and sometimes swelling.
- Activities such as running, jumping, and even walking exacerbate the symptoms.
DIAGNOSIS:
- Physical examination reveals tenderness over the injured area (usually the metatarsals of the foot).
- Swelling and sometimes bruising (ecchymosis).
- Radiographic studies will confirm the diagnosis. Plain x-rays usually will demonstrate the injury however more advanced studies such as a bone scan, magnetic resonance imaging (MRI), or a CT scan may be required.
TREATMENT/REHABILITATION:
- Rest, ice, and elevation are the initial mainstays of treatment.
- Crutches are of benefit in the acute period in addition to possible splinting or casting.
- Rehabilitation once healing has been confirmed includes stretching and strengthening. Stronger muscles absorb shock better thus decreasing stress on bone.
- Appropriate shoe wear, replacing shoes regularly especially in runners. (See recommendations under footwear for runners).
- Appropriate foot biomechanics which may require the use of orthotics.