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Stress Fracture

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A stress fracture is a tiny crack in the bone from chronic overuse. Stress fractures in the foot are commonly found in the metatarsals (called a march stress fracture) and navicular fracture (bone of top of the midfoot).
Stress-Fracture-Foot
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A march stress fracture is an overuse injury caused by repetitive stress to the foot.   A navicular fracture can be caused by a fall, severe twist, or direct trauma to the navicular bone. It can also be caused by repeated stress to the foot, creating a fracture not due to any acute trauma.

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These factors increase your chance of a stress fracture. Tell your doctor if you have any of these risk factors:

  • Participation in high foot impact sports
    • Running
    • Basketball
    • Dancing/gymnastics
    • Jumping events in track
  • Soldiers/military recruits
  • Osteoporosis
  • Women with amenorrhea (absent menstruation), osteoporosis, or an eating disorder
  • Feet with high arches (march)
  • Use of poor or improper footwear (march)
  • Trauma (Navicular)

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If you have any of these symptoms, do not assume it is due to a march stress fracture. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Pain in the middle of the foot
  • Swelling of the foot
  • Foot feels better when resting
  • Foot feels worse with activity

Symptoms of a navicular fracture include:

  • Vague, aching pain in the top, middle portion of your foot, which may radiate along your arch
  • Increasing pain with activity
  • Pain on one foot only
  • Altered gait
  • Pain that resolves with rest
  • Swelling of the foot
  • Tenderness to touch on the inside aspect of the foot

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Your doctor will ask about your symptoms and medical history, and perform a physical exam, which will include a thorough examination of your foot. Other tests may include:

  • X-ray — to take a picture of possible bone fractures
  • CT scan — to take a picture of possible bone fractures
  • MRI scan — to take a picture of possible bone fractures (this is particularly useful with stress fractures)

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Rest is the first thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks. Once you are ready to restart activity your physician may prescribe physical therapy. The following is a common progression for physical therapy treatment:

  • Begin with non weight–bearing activities, such as swimming, cycling, use of an Alter-G treadmill etc.
  • Next, weight-bearing, nonimpact exercise may be prescribed.
  • Gradually, low-impact activity, starting with walking, will be added to your treatment.
  • Once you can do fast-paced walking with no pain, your physical therapist will give higher impact activities, such as light jogging.
  • This gradual progression will continue until you have reached your pre-injury activity level and no longer feel tenderness of the bone.

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To reduce your chance of a stress fracture and other fractures of the foot:

  • Wear well-fitting, supportive shoes appropriate for the type of activity you are doing.
  • Eat a diet rich in calcium and vitamin D.
  • Do weight-bearing exercises to build strong bones.
  • Build strong muscles and practice balancing exercises to prevent falls.
  • When starting a new sport or increasing your workout, do so gradually.

This content was created using EBSCO’s Health Library

This content was created using EBSCO’s Health Library
RESOURCES:
  • American Academy of Podiatric Sports Medicine

http://www.aapsm.org

  • OrthoInfo.org—American Academy of Orthopaedic Surgeons

http://orthoinfo.org

  • American Academy of Orthopaedic Surgeons

http://www.aaos.org

  • American Orthopaedic Foot & Ankle Society

http://www.aofas.org

CANADIAN RESOURCES:
  • Canadian Orthopaedic Association

http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

http://www.canorth.org

REFERENCES:
  • Fractures, an overview. American Society of Orthopaedic Surgeons website. Available at:  http://orthoinfo.aaos.org/topic.cfm?topic=A00139&return_link=0 Accessed November 17, 2008.
  • March fracture. DynaMed website. Available at:  http://www.ebscohost.com/dynamed/what.php
  • Metatarsal stress fracture. Merck Manuel website. Available at:  http://www.merck.com/mmpe/sec21/ch324/ch324m.html Accessed November 17, 2008.
  • Metatarsal stress fractures. Sports injury website. Available at:  http://www.sportsinjuryclinic.net/cybertherapist/front/foot/metatarsal.htm Accessed November 17, 2008.
  • What is a stress fracture and how should it be treated? American Academy of Podiatric Sports Medicine website. Available at:  http://www.aapsm.org/ct0398.html Accessed November 17, 2008.
  • 4/24/2014 DynaMed’s Systematic Literature Surveillance  http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.
  • Coris EE, Lombardo JA. Tarsal navicular stress fractures. American Family Physician website. Available at: http://www.aafp.org/afp/20030101/85.pdf . Accessed June 26, 2007.
  • Stress fractures of the foot and ankle. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00379 . Accessed June 26, 2007.

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