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Foot/ankle Plantar fasciitis Achilles tendonitis Ankle sprain Stress fracture Turf Toe
Calf/Lower Leg Shin splints Tibial stress fracture Compartment syndrome Gastrocnemius strain
Knee Patellofemoral syndrome illiotibial band syndrome Anterior Cruciate Ligament Injury Patellar tendonitis Cartilage injury Knee Arthritis Pes anserine bursitis
Hip Trochanteric bursitis Groin Pull Piriformis syndrome Hamstring strain Hip Ostenonecrosis Hip Arthritis
Shoulder Shoulder Adhesive Capsulitis Dislocation Burners/stingers Shoulder Separation Arthritis Rotator Cuff Injury
Elbow Biceps tendon Rupture Lateral Epicondylitis Dislocation Olecronon Bursitis Biceps Tendonitis Medial Epicondylitis
Wrist/ hand Flexor Tendon Injury Mallet Finger Ulnar Collateral Injury of Thumb
STRESS FRACTURE

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.

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