Stress Fractures of the Foot and Ankle: Causes, Symptoms, Treatment and Recovery

A stress fracture is severe bruising or a small crack within a bone. Repetitive activity and overuse are the two main causes of stress fractures. These are common among athletes such as runners and the ones who play running sports such as basketball and soccer.

Stress fractures are usually caused when there is a change of activities by an individual such as changing your exercise regime, increasing the intensity of workouts suddenly or making a change in the surface where they previously worked out. In addition to these, the risk of stress fractures increases if you are suffering from osteoporosis or any other related disease that has weakened your bones. In these cases, even the normal activities can lead to a stress fracture.

It is important to refrain from indulging in any high impact activities for an adequate period of time while you are recovering from a stress fracture. Returning to physical activities too quickly will not only increase the time of recovery but will also increase the risk of injuring the foot/ankle again which can lead to a complete fracture.

Most of the cases of stress fractures of the foot and ankle are reported in the 2^nd and 3^rd metatarsals which are thinner than the other metatarsals and the navicular. Stress fractures are mostly overuse injuries. They are caused when there are repetitive forces resulting in microscopic damage to the ankle or foot bones. These repetitive forces are not strong enough to cause a complete fracture. Stress fractures occur when an athletic movement is repeated so often that the weight bearing bones on the foot are unable to heal between the exercise sessions.

Bones are in a constant turnover state, known as remodeling. This means that a new bone replaces the older and worn out bone. In case of a repeated vigorous physical activity, the breakdown of the bones occurs rapidly but there is not enough time available to the body to repair or replace the worn-out bone. This leads to the weakening of the bones and they become vulnerable to stress fractures.

 

Causes of Stress Fractures of the Foot and Ankle

A sudden increase in the physical activity is the main reason of a stress fracture. It can be due to the increase in the frequency of exercise or the intensity and duration of exercise. Even if you are a non-athlete, a sudden increase in the physical activity can increase the risk of a stress fracture such as walking for too long on a particular day while you are on a vacation. Changing your shoes can also cause stress fracture if the new shape of the shoe does not allow your foo to absorb the repetitive forces.

Here are the other factors that can lead to stress fractures of the foot and ankle:

• Bone Insufficiency: If you are facing any condition that leads to the weakening of your bones such as osteoporosis or are on certain long term medications, you are at a risk of a stress fracture even if you are doing normal routine activities. Female athletes are at a greater risk of stress fractures than male athletes because of the decrease in the bone density by a condition called female athlete triad. When the bone mass of a person decrease due to any reason, the risk of a stress fracture increase.
• Poor Conditioning: Not letting your body get accustomed to a certain thing and trying to do too much too soon can also lead to stress fractures. It is important to increase the time of any physical activity gradually so your body and muscles can get conditioned to it.
• Improper Technique: The risk of a stress fracture increases if there is anything that alters the mechanism of how your foot strikes the ground on impact such as the surface or the footwear you are wearing. Improper techniques lead to one part of the foot bearing more weight than the other part leading to a stress fracture. Changes in surface such as playing tennis on a grass surface and playing tennis on clay has different impact on the foot and can cause a stress fracture if the foot does not land on the ground evenly. Not wearing proper footwear can also increase the risk of a stress fracture as it is not able to absorb shock efficiently leading to fractures and sprains.

Pain and swelling are the most common symptoms of stress fractures of the ankle and foot. The pain worsens when you put weight on the injured foot. These are some other signs and symptoms of stress fractures:

• Pain intensifies during normal daily activities and lessens after rest
• Swelling on the outside of the ankle or the top of the foot
• Possible bruising
• The point of fracture is tender to touch

Diagnosis

If you experience any of the symptoms mentioned above, it is important to visit a doctor. The doctor will conduct a physical examination of the foot and will ask about the symptoms and how the injury occurred. They will look for areas with tenderness and will apply gentle pressure to the bone and check the intensity of the pain and the location of the fracture.

To further help with the diagnosis, the doctor will also conduct imaging tests such as X-Rays and MRI. X-Rays clearly show which part of the bone has sustained the stress fracture. If the doctor fears there is a damage to the ligaments and muscles attached to the fractured bone, they will also conduct an MRI test to make sure the treatment plan is made accordingly.

 

Treatment Options

The goal of treatment of stress fractures is to relieve pain and help you get back to the normal activities without damaging the bones any further. The treatment for stress fractures depend on the severity and they are treated non-surgically most of the time. However, in more severe cases, a surgery may be needed.

 

Non-Surgical Treatment Options

The R.I.C.E. Method: Rest, ice, compression and elevate is an effective method to reduce swelling and pain caused by a stress fracture. It is important to initiate is as soon as the injury takes place. Icing can help reduce pain, swelling and inflammation. 20 minutes of icing at a time is more than enough. Keeping the ankle above your heart also reduces swelling and pain. Therefore, the doctor will recommend an elevation of the injured foot. It might be time consuming as it requires icing multiple times a day, keeping the injured foot non-weight bearing, keeping it wrapped and elevated, but it helps in reducing pain and swelling which is need for other treatment.

Footwear: It is important to wear shoes with cushioned heels and the ones that provide good arch support. Do not wear old and worn out shoes and try wearing shows that provide laced support in contrast to open sandals. Keeping arch supports and heel pads in your shoes at all times provide the much-needed support to the heel and your entire foot. It is important to place these supports in both your shoes even if you have a stress fracture in just one foot.

Keeping the Foot Non-Weight Bearing: It is important not to put any weight on the affected foot. Your physician will ask you to make the broken foot non-weight bearing as weight on the broken bone will affect its recovery process and will slow down the time it takes to heal. Also, it may lead to complications leading to the need of surgical procedure. Here are some mobility devices to help keep weight off the injured foot

Traditional Crutches: Crutches are an inexpensive and widely used method to keep your injured foot non-weight bearing. It, however, has many drawbacks. Most of the people using traditional crutches complain of pain in their arms, underarms, wrists and hands. It also limits the use of your hands which makes routine tasks impossible for you to do. There are also chances that you will put some weight on the injured foot which can increase the recovery time.

Knee Scooter or Knee Walkers: The best traditional crutches alternative is knee scooters or knee walkers from KneeRover. These are easy to use mobility devices that will keep weight off the injured foot while also keeping you mobile. You can rest the injured leg on the padded platform provided on the knee scooter and can move anywhere with the wheels provided at the bottom. They are also efficient for long distances and will not cause any more harm to the injured foot while you are in the recovery phase.

Casting: You will be advised about the protection you need to wear. It can range from braces and casts to protective footwear. It typically takes 3-6 weeks to recover from a stress fracture.

 

Surgical Treatment

While it is rare, a surgical treatment may be conducted in case the stress fracture is severe. The procedure involves placing a fastener in the foot to provide it support. This is known as internal fixation. Plates, screws and pins are commonly used to fix the bones.

 

Prevention

Here are some tips to prevent stress fractures:

• Eating a healthy diet
• Using proper equipment
• Starting a new activity slowly and giving your body time to condition to it
• Adding strength training to the workout regime

 This is for informational purposes only, please remember to consult your doctor for medical advice and treatment.

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