Jeffrey R. Carlson, MD
The human skeleton is a remarkable structure that supports our body and allows us to walk upright, run with the wind, bend over to pick up a child, carry heavy loads and hundreds of other tasks every day. The main component of our skeleton is bone, a mineralized, living composite that grows throughout much of our lives, constantly remodeling itself in a complex process that allows it to grow stronger to meet additional weight bearing or activity needs. However, bone can be weakened, by disease, poor nutrition, smoking, cancer treatments and other medications. Bones can also be damaged when additional stress is added too quickly for the bone to bear. This is what happens in a stress fracture.
Stress fractures are miniscule fissures that occur in bone(s) when they are placed under too much pressure, are overused or weakened by bone loss. While they can happen anywhere in the body, they are most often seen in the feet, ankles, and lower legs, because those areas bear more of the weight of our body. Stress fractures are often seen in the following:
- New military recruits
- Those who just begin running or walking for exercise
- Track and field athletes
- Dancers and gymnasts
- People with foot problems
- People with osteoporosis
- People who smoke
Symptoms include pain in the area of the stress fracture, especially with activity. There may be swelling or tenderness. Pain tends to decrease with rest.
Stress fractures can be treated at home with modified activity, rest, icing and the use of OTC anti-inflammatories, such as Ibuprofen or Aleve. If the pain persists, it indicates that an appointment with me is necessary to get to the root of the problem.
When you come to see me for a consultation, I will do a physical examination and ask you lots of questions about your pain and when it started. New stress fractures tend not to show up on x-ray and may take a month to become evident on radiograph. I will often get x-rays to rule out other problems, but I tend to diagnose new stress fractures more often based on our discussion of your activities and the location of the pain. Occasionally, I will order a bone study or an MRI to give me more information. Of the two, the MRI is most helpful, it can detect new stress fractures and can help me distinguish between bone or soft tissue injury.
Conservative treatment will be more modified activity and rest. I may put you in a boot, special shoe or give you crutches to make healing easier by removing your weight from the fractured bone. Rarely, stress fractures will require surgery to fix the bone when it just won’t heal on its own or in the case of an elite athlete who needs rapid healing to return quickly to sports.
Some bones in the foot and ankle can be tough to heal when fractured because they don’t have a good blood supply. Occasionally, I will order a bone growth stimulator, which runs a low level electric current through the bone, to speed the healing process. The bone growth stimulator will have to be worn at least 3-4 hours a day for several weeks to months for benefits to be realized. Smoking is terrible for your bones, restricts oxygen in the blood and prevents healing, so it is really important that you quit smoking with stress fractures.
It is easier to prevent stress fractures than to heal them. Always wear supportive footwear and replace it regularly when it gets worn. When starting a new exercise or workout routine, build time and intensity gradually, by no more than 10% a week. This allows bones to adapt and strengthen over time. Cross training is important as it can prevent too much stress on particular bones and strengthen other bones which can help bear the load of the body and increased activity. Good nutrition is important for healthy bones. Eat whole, unprocessed foods that are high in calcium, Vitamin D and protein. Getting regular unprotected sun exposure for up to 15 minutes a day can also help you get extra Vitamin D. You may need to take supplements if you have a Vitamin D Deficiency.
Stress fractures are a common problem and tend to be more of a nuisance than major orthopaedic issue. Getting the appropriate medical care promptly can help you to recover faster and to get back to the activities you enjoy.