Stress Fractures

A stress fracture is a special type of break in the bone. It will occur when a bone is exposed to too much stress, so it finally gets a crack in it. The crack in the bone does not cause the edges to separate, but it is broken none the less. You will have pain with any weightbearing on the foot.

How Stress Fractures Occur
Stress fractures generally occur in two situations. The first is with bone that has normal strength that is exposed to excessive stress for a period of time, and finally it will crack. That generally occurs in people who are fit, but are doing excessive activities. This type of stress fracture shows up in army recruits who go on forced marches of 25 miles or so. They then develop foot pain caused by a stress fracture in a metatarsal bone.

The other situation occurs in people are not doing excessive activities, but rather just normal activities, but their bone that is very weak. This usually occurs in women who have osteoporosis, typically women who are postmenopausal. General activities like walking may put more stress on the weakened bones in the foot than they can handle. A stress fracture can then ensue.

In the foot, the metatarsal bones are typically the ones that develop stress fractures. Sometimes athletes will get a stress fracture in the navicular bone in the midfoot.

Diagnosis
Generally when a stress fracture occurs there is point tenderness over the site of the fracture.

Xrays taken within the first 3 weeks after the fracture will usually not show it. If they are taken after 3 weeks they will usually demonstrate evidence of the new bone forming at the site.

A bone scan is another radiographic study that will show the stress fracture very well, and at any time after the injury.  An MRI study will also show a stress fracture very well, and will do so immediately after the injury.

Treatment
Stress fractures are generally treated by limited activities while the bone hurts, and then progressive weight-bearing in a postoperative shoe or even a regular shoe based on discomfort.

Older patients who develop stress fractures should see their physician and have an evaluation for osteoporosis.

Look here for a general discussion about Fractures.