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 and used to be called march fractures in the military.
They always hurt on the top of the foot and usually develop a localized swelling about an inch behind the base of the toes. On the first exam, it is not unusual for xrays not to visualize the fracture line because the fracture does not go across the entire shaft of the bone. A high level of suspicion for fracture and treating the foot as such is very important. If a stress fracture is not cared for with rest and immobilization, it can fracture the entire way and then become unstable.
Unfortunately the stress fracture nearly always develops in the middle of the shaft of bone, where it is thinnest and has the poorest supply of blood for healing. If it breaks or is constantly moved by walking on it, then the bone will not heal together. Even under ideal care, with rest and cast immobilization, some movement is possible with weightbearing.
Often a bone stimulator is presribed to hasten and optimize the healing environment.
It is common for the fracture to take three or four months to heal. If the fracture completes and is not healing, surgery is
needed to plate and secure the fracture for healing.
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