Stress Fractures

Stress fractures are incomplete breaks in the bone. In our office we see stress fractures in metatarsals, the long bones of the forefoot. They are often found after excessive walking or running and used to be called “march” fractures in the military.

Pain and swelling is nearly always on the top of the foot, not the bottom, and usually about an inch behind the base of the toes.

On the first exam, x-rays are ordered and when they are read it is not unusual for the x-ray not to show the fracture line because the fracture does not go across the entire shaft of the bone.  However, the symptoms will produce a high level of suspicion for fracture and treatment as such is very important.  Treatment depends on the location and extent of the fracture.

If a stress fracture is not cared for with rest and immobilization, the bone can fracture the entire way and then become unstable and it will not heal properly.  At the least, stiff soled shoes are recommended and a cast or cam walker boot or surgical shoe is given depending on the x-ray findings and severity.  Sometimes a Jones dressing is applied to reduce edema and relieve pain and crutches are ordered if necessary. 

Sometimes a bone stimulator is prescribed to hasten and optimize the healing environment.  It is common for the fracture to take two to four months to heal.  If the fracture is not healing, surgery is needed to plate and secure the fracture for healing.  X-rays are repeated in about four months.  Physical therapy is rarely needed.  But Novacare Physical Therapy has an antigravity treadmill for the serious runner who cannot wait for complete healing of the fracture.

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