Stress fractures are very small cracks in the bone. Often times, these cracks are so small they don’t even show up on an x-ray for 4-10 weeks. These tiny, hairline breaks are most often caused by repetitive stress. We see this most often in runners and triathletes. The main culprit is a rapid increase in mileage while training for long distance events. Stress fractures are also caused by osteoporosis, abnormal foot structure (such as high arches), or other foot deformities.
Wearing the right shoes for your foot type is critical. You have to choose the right shoes for your foot type in order to prevent stress fractures. If you suspect a stress fracture, stop running and don’t ignore it. They can worsen if left untreated. You might also be at risk for a pattern of recurring future injury.
You might have a stress fracture if you notice any of the following symptoms:
• Pain either during or after normal activity.
• Pain which goes away while resting, but returns when standing or walking.
• “Pinpoint tenderness” (pain right at the site of the suspected fracture) when touched
• Swelling of the foot without any bruising
• Bruising over the aching sore area of your foot
Sprains and fractures can have very similar symptoms. But often with a sprain, a broader area of the foot will ache, rather than just a certain point of tenderness. We can easily diagnose the problem and start you on the appropriate treatment to make sure you get to your activities as fast as possible. Keep in mind that some sprains and dislocations can be severely disabling. Without the right treatment you can develop crippling arthritis.
The best treatment of a metatarsal stress fracture will depend on the specific fracture, but may include:
• Rest. Sometimes rest is all that is needed to promote healing of a stress fracture of a metatarsal bone.
• Avoid the activity that led to the fracture. It is important to make sure that you don’t injury the bone further. If running caused the fracture, stop running until you get an evaluation. Don’t make it worse. Sometimes you might have to stay off the foot entirely with the help of crutches or a wheelchair in order to allow it to heal, but this is rare.
• Immobilization, casting, or stiff shoe. A cast, stiff shoe or fracture walking boot might be needed to protect and stabilize the fractured bone while it is healing. This is the most common treatment for stress fractures of the foot.
• Surgery. Depending upon the extent of the injury, some metatarsal fractures will heal much better with surgery to re-align and stabilize the bone. But don’t let that scare you. The vast majority of stress fractures will heal completely without surgery. If you see a podiatrist who focuses on athletes, you should be able to work together to find a way to stay fit while your stress fracture is healing. The only stress fractures that need surgery are ignored. If you try to “tough it out” and keep running on a stress fracture, it can break completely. If this happens, and the broken bone fragment moves or shifts out of place (which foot surgeons call displacement) that is when you might need to have the bone re-aligned in surgery. Get treatment early if you think you have a stress fracture.
• Follow-up treatment. You will receive very particular instructions for treatment after both surgical and non-surgical metatarsal fracture treatment. Physical therapy, strengthening exercises and rehabilitation will help to get you back to your athletic activities as quickly as possible.
Dr. Christopher Segler is a San Francisco Podiatrist, Foot Surgeon and Ironman Triathlete. He is an avid runner with an interest in sports medicine. He has written a chapter in the Handbook of Podiatric Sports Medicine. He seems to attract patients who are runners and triathletes hoping to get back to running and cycling as quickly as possible.
