What is a Stress Fracture of the Leg and Foot?
A fracture (or broken bone) is a disruption, or break, in a bone. Some fractures, called stress fractures, are microscopic, and because they are not displaced (when the bone has shifted its position), they cannot initially be seen on regular x-rays. After time and healing starts to occur, the bone repair process shows up. Stress fractures occur as a result of repetitive overuse. In the foot, stress fractures usually are in the metatarsal bones in the ball of the foot, especially the second. Common sites for stress fractures in the leg include the tibia and fibula. Though 50 percent of stress fractures occur in the lower leg, stress fractures can happen to any bone in the body. Medical studies have shown that female athletes seem to experience more stress fractures than men.
What is Metatarsal Stress Fracture?
There are five metatarsal bones, each of which travels out to a toe in the foot. The metatarsals connect with the tarsal bones in the hindfoot (rear of the foot) and the phalanges (toes) in the front of the foot. There are several kinds of metatarsal fracture, including stress fractures as well as more acute, and possibly multiple fractures of any of the five metatarsals.
Stress fractures (hairline breaks) are common in the metatarsals. They are usually caused by repetitive stress, such as with a new military recruit who has a sudden increase in his/her need to march. Other metatarsal fractures typically result from a direct blow to the foot, resulting from a trauma such as a fall from a height.
Causes of Stress Fractures of the Leg and Foot
Causes of stress fracture include:
- Training errors (in athletes) such as too rapid an increase in a runner's mileage
- Impact of an unfamiliar surface (a runner who has switched from a treadmill to a concrete path)
- Stress caused by another foot problem, such as bunions
- Wearing poorly cushioned shoes while walking on hard surfaces
- Abnormal foot structure, such as flat feet
- Poor shoes
In sports like tennis, track and field, gymnastics and basketball, the repetitive pounding of the foot on the ground can cause stress fractures of the foot and leg.
Symptoms of Stress Fractures of the Leg and Foot
General symptoms of a stress fracture include a sharp pain while walking and mild swelling, in the affected area. It is uncomfortable when pressure is applied to the small area surrounding the site. Acute fractures may result in inability to put weight on the foot, swelling, and more severe pain. Even acute fractures usually have little displacement when they occur in a metatarsal bone.
When you visit your physician with pain in the lower leg or knee, you will be asked questions about your injury and medical history. The doctor will physically examine the injured area, determining the cause of your discomfort. The doctor will want to know the following:
- What hurts? This helps identify the affected area.
- What happened? This helps determine the mechanism of injury.
- What was new after the injury? With stress fracture, there is likely to be localized pain and tenderness.
- Have you injured this part of your body before? This helps the doctor identify a chronic weakness or the likelihood of further problems.
- What did it feel like at the time of the injury? With stress fractures, patients are usually unable to identify a precise moment of injury, but they see a pattern of recurring pain in a particular area.
- Where did the injury occur, and under what circumstances? Stress fractures are closely associated with particular sports and activities, such as basketball, aerobics, and running.
- Are you susceptible to stress fractures due to a known condition such as osteoporosis, anorexia, or obesity?
In analyzing the questions above, your doctor may be able to diagnose your injury strictly on the basis of a physical exam. The doctor will focus on the injured area, comparing it to the uninjured leg or knee. He or she will evaluate visible signs of injury such as tender skin, swelling, and differences in joint mobility or appearance.
The doctor usually presses and squeezes — palpates — the injured area. While this may produce pain, it helps locate the injury and any structural abnormalities. The doctor looks for:
- Localized tenderness
- Sounds of grating or grinding
- Restrictions in the range of motion of the injured area
- Inability of the injured part to bear weight
X-rays usually miss small skeletal traumas such as stress fractures. Sometimes the doctor may advise a bone scan. Other tests providing three-dimensional images of skeletal trauma include computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.
Treatment of Stress Fractures of the Leg and Foot
Stress fractures are usually treated conservatively, without surgery. Rest of the injured area is essential, and usually requires suspending the activity that caused the injury for six to eight weeks. The treatment regime known as R.I.C.E., involving rest, ice, compression, and elevation, is an effective method for healing stress fractures. Sometimes a cast is required, especially if it may prevent a more serious fracture. Additional treatments include:
- Stiff-soled or wooden shoes
- Avoidance of high-impact activities
- Keep weight off the foot
- Use of ice
- Use of a bandage
- Use of a cast
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
A highly competitive athlete may find it difficult to comply with the period of immobilization necessary to bring about complete healing of a stress fracture. Sometimes an orthopedic surgeon will recommend surgical treatment in these cases.
Rehabilitation After Stress Fractures
Once the stress fracture heals, sports activities should be renewed gradually, with warm up and cool down exercises used before and after strenuous workouts. It is important to eat calcium-rich foods as part of a healthy diet. Replace any old or ill-fitting athletic shoes. Slowly increase any new sports activity. For example, do not immediately start running five miles a day; instead, gradually build up your mileage on a weekly basis. Running can also be done on alternate days.
Each fracture has its own distinguishing characteristics and treatment options, so physicians need to be attuned to both detection and management of these injuries. Medical studies show that women, especially female athletes, experience more stress fractures than do men. Many orthopedists explain this by referring to a condition known as "the female athlete triad." Components of this triad are:
- Eating disorders such as bulimia and anorexia
- Amenorrhea—(infrequent menstrual cycles) due to rigorous exercise
- Osteoporosis (brittle bones), especially in post-menopausal women
When a woman's bone mass decreases, the likelihood of her getting stress fractures goes up.
People with some form of metabolic bone disease, diabetes, rheumatoid arthritis, or cancer, as well as those who smoke or consume large amounts of alcohol, are also more likely to develop stress fractures. Preventing these injuries often requires proper management of other medical conditions, as well as changes in lifestyle.
Athletes involved in tennis, track and field, gymnastics, basketball, and dance are all very susceptible to stress fractures. Participants in these activities should be aware of the risk, counterbalancing it as much as possible with rest between workouts, sufficient warm-up before and after exercise, and the use of proper shoes.
The absence of pain does not always indicate the complete repair of a stress fracture, and re-injury is common if patients return to sporting activities too soon. If the symptoms of stress fracture are recognized early and treated appropriately, allowing for complete healing, most people can eventually return to sports at their normal playing level.
The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.