How to Spot and Treat a Stress Fracture


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Many athletes, especially runners, know to fear the all-too-common stress fracture. But how many of us really understand this kind of injury?

A stress fracture is a small, incomplete crack in a bone that is caused by repeated stress in an area in the body. 95% of stress fractures develop in the lower extremity; this kind of break accounts for 10% of all running injuries. Stress fractures are a common injury in runners because of the repeated motion they go through while striding over thousands of steps.  Stress fractures commonly occur in runners when they have too many miles on their shoes, suddenly change the surface on which they are running, or ramp up the intensity level of their workout.

Signs of a Stress Fracture Only a thorough examination can determine whether you have a stress fracture

The symptoms of a stress fracture are: tenderness over a localized area, pain when you put weight on the affected limb, and slight swelling around the area of the fracture. Runners who are most prone to getting stress fractures are women with amenorrhea (loss of menses) or post-menopausal women, because of the role estrogen plays in strengthening bones. Thinner athletes, and people who are not getting the proper nutrients to replenish their bones, are also at an increased risk for stress fractures.

It is important as a runner to make sure that you are getting the proper nutrients to keep your bones strong in order to avoid developing stress fractures. It is recommended that you get 1000 mg of Calcium per day and 200 IU of Vitamin D per day. You should also maintain a Body Mass Index (BMI) of at least 18.5 or higher and a body fat level of at least 14%. All of these factors will help ensure that your bones have the right nutrients to sustain themselves even through daily running stresses.

If you think that you may have a stress fracture then the first thing to do is to decrease the amount of exercise you are doing. It is also important to go see your doctor or podiatrist so they can take an x-ray of the site. X-rays are not always able to detect a stress fracture and a bone scan may be required. And remember: just because you can walk does not mean you aren’t injured!


Why You Can Sometimes Walk on a Sprained or Broken Foot

Not too long ago, I saw a patient who twisted his ankle a few days previously while playing basketball. It hurt at first, but he told me in the office that the pain was about a 4 out of 10. He was able to wear his shoes and tolerate the pain when he was walking. He didn't think it was very bad, since he was able to walk on it, but felt it was worth getting checked out because the pain was still lingering.

When I saw him, the foot was a bit swollen and bruised, but it really didn't look so bad! There was a little bit of pain to the touch, but nothing that made him jump. I took some x-rays to see what was up. Well, he wasn't imagining the pain that he had: the x-ray showed that he’d suffered a partial fracture at the base of his 5th metatarsal bone. This is not an insignificant injury.

When you sprain your ankle, the ligaments that support the ankle are often damaged. What also happens is that a sudden tension on the tendon courses down the side of the ankle. Sometimes, that tension is strong enough to break the bone to which it is attached. Often times, it results in a complete fracture of the 5th metatarsal base, which most often requires foot surgery to heal. My patient was fortunate because the foot fracture was not complete. But, because there was significant weakening of the bone, it was still important to treat the fracture aggressively so it didn’t fully break and require later surgery.

Even with a complete break of a bone in your foot or leg, you will still be able to walk. Sure, the walking will be painful, but don't discount the possibility that you have fractured a bone simply because you are able to bear weight on the injured limb. It is vital to visit your podiatrist in Houston to have the foot evaluated for a broken bone. The best chance that you have to heal the fracture without surgery is to get it checked immediately.

My patient was fortunate to get off pretty easy with this injury. He wore a fracture boot for the next 6 weeks and made a full recovery. Don't take the chance! If you have had an injury, whether you suspect a broken bone or not, get it checked by your Houston podiatrist to make sure you have the best treatment possible.  

Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.