What is a stress fracture?
A stress fracture is a crack in a bone that is caused by excessive or abnormal stress. If left untreated, this initial crack can progress and eventually fracture all the way through the bone.
A stress fracture can occur in any bone, but is commonly seen in the metatarsal bones in the fore foot, particularly the 2nd and 3rd metatarsal bones.
A “Jones fracture” is the term used for a fracture which occurs about 1.5cm from the base of the 5th metatarsal.
What does a stress fracture feel like?
If you have a metatarsal stress fracture you will usually feel pain on the top of your foot over the affected bone. There may also be swelling and tenderness over the fracture site.
The pain can be dull or sharp, and may be constant or intermittent. Usually the pain will be worse during or after activity that requires bending of the foot, such as walking, running, jumping or hopping.
In addition to pain, you may notice a crunching noise (crepitus) over the fracture site. This generally only occurs if the fracture has progressed to a complete fracture, in which case you may find that the pain prevents you from weight bearing on the foot.
What causes a stress fracture?
Often people who have a stress fracture cannot remember any particular injury or event which caused their foot pain.
Some factors that can contribute to the development of a stress fracture include:
- Anything that places excessive or abnormal stress on the metatarsal bones. This may be due to underlying foot deformities (eg, bunions (hyperlink)), poor foot biomechanics (eg, flat foot (hyperlink)), or obesity.
- An increase in activity levels, particularly if this occurs suddenly or without proper conditioning.
- Running on hard or uneven terrain, especially if running long distances.
- Unstable shoes.
- Conditions that cause decreased bone density (eg, osteoporosis) can make bones more susceptible to stress fractures.
How is a stress fracture treated?
Stress fractures are usually diagnosed by x-ray, however not all stress fractures will be visible on x-ray. If a stress fracture is suspected following examination by a podiatrist, treatment will usually involve immobilising the foot to allow the bone fracture to heal.
Depending on where the stress fracture is, a special shoe or boot may be recommended to allow your foot to rest while still enabling you to weight bear on the foot. Treatment will also include advice on gentle exercises and stretches to avoid developing stiffness in your joints after your foot has been immobilised.
At times, crutches will be recommended to take weight off the foot but again this depends on the location of the fracture and how far the stress fracture has advanced. A Jones fracture (of the 5th metatarsal) is typically very difficult to heal and may require a longer period of non-weight bearing for recovery. Surgery may also be indicated for treatment of a Jones fracture.
If you have had a stress fracture it is important to take steps to prevent a future recurrence. Depending on your situation, orthotics may be recommended to improve biomechanics of the foot and reduce pressure on the metatarsal bone. Advice on appropriate footwear is also critical for the prevention of stress fractures.