What is a Stress Fracture? This is an injury of bone that occurs due to repetitive microtrauma.  This differs from a traditional fracture because the break of the bone is not through-and-through but rather is more like cracks in the shell of a hard boiled egg.    This condition is a result of increased activities over a short period of time and can also occur in cases where activity level is the same but weight has increased in a short period of time.  These injuries can occur in any bone, but most commonly in the foot occurs in the heel bone (calcaneus) or the second metatarsal (the bone behind your second toe. 

How is this treated?  Because there is damage and weakness now present in the bone, it is vital to protect the bone while it heals. 

  • First appointment: At your first appointment, your doctor will examine your feet and take x-rays of the painful foot to determine if there are any other causes of pain.  Stress fractures do not appear on x-rays when they first occur.  Rather, it takes a few weeks until the reaction of the bone in response to healing the stress fracture is present.  If you are diagnosed with a stress fracture, there are initially two main causes to your pain that need to be addressed.
    • Inflammation: This is what causes the bone to be painful.  Inflammation can be managed with oral non-steroidal anti-inflammatories, icing, and in some cases topical anti-inflammatory medicines.  These methods are typically needed only in the first few weeks of treatment.
    • Rest: In order to allow the bone to heal from a stress fracture and to prevent a through-and-through fracture in the future, pressure must be removed from the bone to allow it to rest.
      • Immobilization: Your doctor will recommend that you are fitted with a CAM walker boot, which allows some mobility while protecting and off-weighting the injured bone.
      •  Weightbearing restrictions:  Depending on the severity of your condition and also your daily functions, your doctor may recommend modifications to your activity, including work restrictions to prevent excessive walking on the injury.
  • At your first follow-up visit: Your doctor will re-assess your condition and determine what the next step needs to be.
    • If your condition is nearly 100% improved the focus of treatment is to continue to allow healing of the injured bone.  When the acute pain is reduced, this tells us that your inflammation has nearly completely resolved.  This places our focus next onto ensuring that the bone is protected until it is completely healed.
      • Continued use of CAM boot: depending on your symptoms at follow-up, you will either be instructed to continue using the cam boot or begin transitioning into supportive athletic shoes.
      • Once stress fracture have healed: orthotics may be recommended to prevent future stress fractures.  Some foot types are predisposed to abnormally high amounts of stress on given bones in the foot.  This is especially important to address in athletes and active adults.
    • If your condition has not improved, this tells your doctor that the next step will be implementation of more restrictive therapies.
      • Casting: In some people, CAM walker boots may not allow adequate immobilization and protection of the injury.  Fiberglass casting ensures more protection as it cannot be removed and will continuously hold the foot in a position for rest.  Casts are typically applied in the office and left on for a period of 2 weeks.
    • If things still aren’t improving: If you have stubborn stress fracture even after the above mentioned treatment, your doctor will re-assess you to determine the next course of treatment.
      • Further Studies such as obtaining an MRI or CT scan of the ankle is sometimes necessary to ensure that there are no additional cysts or damage within the injured bone. These findings do not always show up on x-ray.

Stress fractures have great potential for improvement with initial therapies if there is strict adherence to your doctor’s orders.  It is vital to initiate treatment as soon after an injury as possible.  This ensures the soonest return to regular activities and resolution of pain.

Dr. Misty McNeill
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D.P.M. - Founder of Prairie Path Foot and Ankle Clinic