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Are You a Mile Away From a Stress Fracture? Don’t Ignore Pain to Your Feet

By Dr. Melva L. Baker, DPM

The weather is nice and warm, the sun is shining bright and you have your running shoes waiting by the door. Today is a great day to go out for your daily run. There’s only one problem: you have pain in your feet and can’t walk. A stress fracture may be the issue.

Stress fractures are one of the most frustrating injuries I see in my practice with runners. The frequency of my experiences with these injuries increase during what I call “marathon season” (aka, now).

What is a stress fracture?
Stress fractures are a tiny crack in the bone that usually occurs from overuse. Stress fractures are among the most common sports-related injuries. More than half of stress fractures occur in the lower extremity: in the tibia, metatarsals, femur, fibula and navicular bones.

What causes stress fractures?
Stress fractures happen mostly in the foot where bones get more pressure from bearing weight. When you are physically active, your muscles help absorb shock from the impact of hitting the ground. As your muscles become tired and less able to absorb the shock, they transfer the added stress to your bone. As a result of repetitive use, a stress fracture develops.

    Other things to keep in mind that may cause a stress fracture are:

  • Bone insufficiency: certain conditions such as poor nutrition, osteoporosis or eating disorders can cause the bone to lose strength and density. The weaker or less dense your bones are, the more susceptible they are to getting a stress fracture.
  • Running technique: starting an intense training, new exercise program, or doing too much too soon, may lead to stress fractures.
  • Equipment: wearing worn-out shoes, shoes that don’t fit well, or shoes that are not designed for a specific activity may cause a stress fracture. Shock absorption is the most important characteristic of sneakers. Shoes should be replaced every 350-450 miles.

What are the symptoms of a stress fracture?

    Some things runners with stress fractures might notice:

  • Pain in the foot or leg when exercising that goes away when resting
  • Pain that gets worse with time and can be felt even after rest
  • Swelling on top of the foot or outside of the ankle
  • Bruising or tenderness to affected area

How is a stress fracture diagnosed?
Being able to give a record and history of your symptoms, in addition to an examination of the affected area, will help your podiatrist in making a proper diagnosis. Sometimes stress fractures show up on X-rays, and other times they are not visible. They may show up a few weeks after the injury. If a stress fracture is suspected, a bone scan or MRI (magnetic resonance imaging) may be recommended for confirmation.

At times, an MRI can catch a stress fracture early on. At this point, it is classified as a stress reaction and may only require a few weeks away from running.

What’s the treatment for stress fractures?
The sooner you get treatment for stress fractures (and identify the predisposing factor), the quicker you will recover. If diagnosed early and treated correctly, most stress fractures will heal by themselves in a matter of weeks. But if a person resumes activity too soon, tiny stress fractures become larger and harder to heal.

Rest is the most important part of treatment. Many stress fractures can be managed with non-impact type sports, such as cycling and swimming, and will heal in 6-8 weeks.

    Other treatment options include:

  • Use of ice or a cold compress to reduce swelling: A topical regimen might involve icing the injured area as needed every 3 hours for 15 minutes each time.
  • Use of NSAIDs: Applying a topical NSAID such as Voltaren 1% Gel, or taking an oral pain medication such as Motrin, to decrease the pain in the foot.
  • Use of a brace or splint: Stress fractures in the fifth metatarsal bone, the navicular, or talus bones take longer to heel. A CAM walker is usually used to protect the fractured area, and to keep it free from motion. To keep weight off the foot, crutches may be used until the bone heals.
  • Physical therapy treatment: Seeing a physical therapist after a stress fracture diagnosis will help rehabilitate the injured foot. Physical therapists can provide soft tissue work, balance and proprioceptive training and exercises to rebuild strength.
  • Biomechanical correction: Orthoses designed to correct positioning of foot or deformities may help in preventing recurrences of stress fractures.
  • Nutritional or psychological counseling: If poor nutrition or eating disorders is the cause, consulting these medical professionals is advised.
  • In rare cases, some high-risk stress fractures may need the use of a bone stimulator or surgery if other treatments don’t work.

Don’t Ignore Pain; Take Action!
Many people ignore the pain of their body – especially at first, when it does not hurt too much. Prompt diagnosis and treatment is key in order to minimize the impact of stress fractures. The goal of any treatment is to help you return to all the activities that you enjoy. Following your podiatrist’s treatment plan will help you resume activity faster and prevent further problems in the future.

Dr. Melva L. Baker graduated from the New York College of Podiatric Medicine and completed residencies in Podiatric Orthopedics and Podiatric Medicine and Surgery. Dr. Baker has extensive experience in treating a wide variety of podiatric concerns including common skin and nail disorders, sports-related injuries, diabetic and vascular wound care and biomechanical issues. Dr. Baker’s practice is located at 928 Broadway #904 @ 21st Street. You can reach Dr. Baker by email at drmelvabaker@gmail.com or by telephone for an appointment at 646-783-9491.