Stress fractures appear gradually as an ongoing dull ache in the foot or intermittent while weight-bearing/walking; like in the morning when the foot is put down for the first time.
Metatarsal stress fractures are the most commonly presented type. The human foot has 5 metatarsal bones that form the point where the toes join the foot. They are long, relatively slender bones. The most commonly affected bones are the second, third and fifth metatarsal bones. However, other bone of the foot (like the navicular or calcaneus) can also be affected by stress reactions leading to a stress fracture, and so they shouldn’t be ruled out..
Stress fractures occur due to overloading of the bone. Classic examples include the following:
– an athlete who has made some change to their training routine (increased volume, change in footwear, change in training surface)
– a young female walking too far in a pair of heels or un-supportive shoes such as thongs or ballet flats.
Accurate diagnosis through imaging is usually only possible with a bone scan, CT or MRI which are generally expensive or involve higher radiation dosages. I often diagnose through exclusion; ruling out soft tissue involvement through ultra-sound imaging along with a plain x-ray.
Treatment depends on the severity of the injury and whether there are any time restrictions in place for complete resolution. If you need to return to 100% ASAP, a ‘moon boot’ which immobilizes the foot for 6-weeks is the best option. However, due to the inconvenience of this method, we often try supporting the foot with an orthotic and good solid running shoes. This option runs the risk of a slower recovery however.
For the eager runners, football players and triathletes out there, the Alter-G (anti-gravity) treadmill can be a major part of the rehabilitation process and will help return the athlete back to their pre-injury state quicker than ever before. The Alter-G treadmill has the ability to un-weight an athlete during their running routine, allowing their training to continue, while their injury improves. As their injury improves more and more the Alter-G settings can be adjusted to gradually return the athlete back to full body weight. This is a massive evolution phase for the medical world, as stress fracture patients were usually told not to walk, run or do any weight-bearing activity for a number of weeks during the healing phase.
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