Stress fractures are more common in the lower leg and foot, but are not limited to these areas. They can also happen if you start a new form of exercise and do too much too soon.
Stress fractures can be caused by the impact of an unfamiliar surface (eg road running vs off-road running). They can also be caused by inappropriate shoe wear, causing an excess load in certain areas.
Specific pain with activity over the injured area. This is usually a specific pin point pain that is tender to touch. This pain usually subsides with rest. As the injury progresses, you may feel pain even at rest.
Swelling around the painful area may be present. (this is often subtle)
Stress fracture contributing/risk factors
- Previous stress fractures: if you’ve had stress fractures in the past, you’re more likely to develop them again.
- Weakened bones: Conditions such as osteoporosis weakens your bones, thus increasing your susceptibility to developing stress fractures.
- Nutritional deficits: A lack in vitamin D and calcium can predispose a weakness in your bones. Eating disorders such as anorexia can also lead to a weakened bone structure.
- Women are more likely to develop stress fractures than men (especially if their menstrual cycles are absent/abnormal, eating disorder is present and/or they are osteoporotic)
- Sport dependant: Certain sports that involve a lot of repetitive movements and high impact can increase your likelihood of developing a stress fracture. We commonly see stress fractures in long distance runners, dancers and gymnasts.
- Changes in your training regime: Stress fractures usually happen if you change the intensity, duration and frequency of your training regime. Resting in between training sessions is important to allow your body (and bones) time to fully recover.
- Foot biomechanics: People that have altered foot biomechanics are more likely to suffer with stress fractures. This may include a flat foot, high foot arch or a stiff foot.
How is a stress fracture diagnosed?
Stress fractures are sometimes difficult to diagnose as they don’t always show up on imaging especially if it is in the early stages of the injury.
An x-ray may only be able to pick up the stress fracture after a few weeks. An MRI is the most accurate form of diagnostic imaging available for a stress fracture.
It is important to treat the stress fracture appropriately as well as sorting out any underlying risk/contributing factors to prevent it from becoming a chronic and/or a recurring problem.
Your first step is to reduce the load going through the area. This may mean that you may need crutches to offload the area. You may also need to wear a moonboot (depending on where the injury is) until healing has occurred.
The most important treatment is rest. You need to rest from the activity that caused the stress fracture. You can talk to your physiotherapist about alternative exercise that you can do, so that you do not lose fitness but also so that you do not put any added strain on the area affected by the stress fracture.
Typically stress fractures take between 6-8 weeks to heal, although this time may vary depending on which bone is affected.
It is important not to return to sport too soon, as the problem will just persist and potentially get worse, leading to a chronic ongoing problem.
Once the pain is completely gone and your medical practitioner has said it is safe to resume some activity, it is vital that you ease yourself back into the activity/sport that caused the problem. This re-introduction back to the activity should happen gradually over a 4-6 week period, making sure that you don’t reinjure the area.
Prevention of a stress fracture
The age old saying, prevention is better than cure is once again applicable to this scenario. It is far easier to prevent an issue than to treat it once it becomes a problem. I am going to list a few tips that will not only help with preventing a stress fracture, but any overuse injury.
- When taking part in a new sporting activity, start slowly and build up your tolerance to the activity. Avoid increasing the amount you exercise by more than 10% per week.
- Cross training – by varying your activity, you reduce the repetitive force over a specific part of your body. For example, if you are building up your cardiovascular fitness, you could alternate between running and cycling to reduce the repetitive nature of force over one area. You could also do strength and flexibility training for extra benefit. Your physiotherapist can guide you with this.
- Ensure you maintain a healthy diet. In South Africa we are lucky that we get a lot of our vitamin D from the sun. It is important that you have a diet high in calcium alongside the vitamin D to ensure strong bones.
- Ensure your footwear is correct. Make sure that they fit you well and are not too worn down. If you are concerned about footwear, consult with your physiotherapist, who can guide you as to what the next steps need to be, whether it be a running assessment on a treadmill to choose the correct pair of running shoes or an orthotics assessment.
- Smoking increases your risk of a stress fracture as it has an impact on bone quality.
- If you have any pain on running that is not going away, rather seek help early on so that it does not become a longer- term problem.