Not all fractures (broken bones) are the result of a traumatic accident. Many are caused by the excessive forces on the bone itself due to the architecture of the foot or a person’s walking pattern. These fractures are called stress fractures and occur most frequently in the slender metatarsal bones. Stress fractures can either be due to fatigue of the bone from repetitive mechanical injury or can be insufficiency fractures caused by the bone weakening from osteoporosis or other bone diseases. Fatigue stress fractures occur mostly in athletes that suddenly increase mileage or impact aerobic activities and are also commonly seen in soldiers or hikers.
Most stress fractures occur slowly over a period of time, gradually worsening and eventually cause limping or even the inability to put any pressure on the foot at all. It may take several weeks before signs of a stress fracture is seen on x-ray. It is for this reason that sometimes a bone scan or MRI is necessary to definitively diagnose a stress fracture.
The body’s normal response to a stress fracture is to build up more bone around the fracture which “bridges the gap” between the two fractured ends of the bone.
Treatment usually consists of discontinuing the activity that caused the fracture in the first place and to reduce as much pressure as possible on the foot. This may entail a special surgical wedge shoe, a walking cast, crutches, or a knee scooter. Sometimes external means of healing the fracture is required, such as a bone stimulator or even surgical intervention. If decreased bone density played a role in the cause of the stress fracture, increasing calcium and vitamin D may be required. In the athlete, a biomechanically designed foot orthotic may be required to better distribute the weight-bearing forces on the bottom of the feet.
If you experience foot pain following a sudden burst of exercise after being sedentary or an increase in your impact aerobic exercising, consult Dr. Goldstein for proper evaluation and treatment.