Stress Fracture

from running

Stress fracture is an overuse injury that presents with small or tiny cracks in a bone. The most common sites of stress fracture in the lower limb are the metatarsals particularly the second and third metatarsals. It’s because these bones acquire the greatest impact when walking and running and are thinner than the other metatarsals. The other structures that are prone to stress fracture are navicular, fibula and calcaneus (heel)..

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What are they?

This condition gradually develops. It starts when the muscles are already tired and fatigued that they’re unable to absorb more shock. The muscles will then transfer the increasing stress to the bone. The bones and supporting structures don’t have enough time to heal the damage thus, tiny cracks develop.


In the military, stress fracture is also called march fracture.


Risk factors for Stress Fracture

·        Female

·        Athletes who do frequent running       

·        Height and weight (tall and heavy people put more stress to the lower limb)

·        Sudden increase in physical activity


·        Too much physical activity without less rest periods

·        Changing workout surface

·        Osteoporosis

·        Fallen arches

·        Worn out training shoes


Symptoms of Stress Fracture

The most common symptom is pain. It develops gradually and there is no obvious injury to the athlete. Pain is aggravated by activity and alleviated through rest. It can be associated with swelling and tenderness. Bruising may be present though rare.


How is Stress Fracture diagnosed?

When suspecting of a stress fracture, seek immediate medical help. A patient should discuss the history of the condition to the doctor including activities, diet, work and medications. With enough data, the doctor will proceed to the physical examination of the foot. Areas of tenderness will be checked. Swelling and redness are also assessed.


To further evaluate the foot, the doctor will order imaging scans to observe the bones of the foot. In this case, X-ray will not be helpful because a crack in a bone is difficult to see. It will only be visible several weeks after the bone has healed. The doctor will advise the patient to undergo bone scan, MRI or CT scan to better distinguish the fracture.


How is Stress Fracture treated?

In this condition, treatment’s goal is to relieve and eliminate pain as well as allow the fractured bone to heal. Majority of stress fractures respond to non-surgical treatments.


While the condition is acute, it is recommended to do RICE at home. Use of crutches is also advised to avoid putting weight on the affected foot. The foot needs a long period of rest to recover. For active individuals who don’t want to stop having an activity, low-impact activities like swimming and cycling are recommended. Most stress fractures heal within 4 to 12 months so there’s nothing much to do than rest. There is no need to insist on exercising because the condition will only get worse.


If patients are referred to physiotherapy, treatment will focus on activity modification. Program involves muscle strengthening and generalized body conditioning. Cross training is also performed in physiotherapy. Lastly, preventing another stress fracture is taught to patients.


What can I do today

Is cross training an option

Seek medical advice.  It is likely that you will not be able to run for some time without aggravating the fracture.  Ask your medical practictioner if you can cross train on a low impact high cardio device like the Bionic Runner.  Remember when cross training that the Law of Specificity says that you will get the most bang for your buck out of something closest to running.  Checkout the story on Mick Thwaites, who had surgery on a stress fracture, trained almost entirely on the Bionic Runner afterwards, and 4 month later went on to run 413km in a 48 hour ultra marathon challenge.