Stress fractures often occur in the foot

A stress fracture is often the result of excessive stress. It is not a break in the true sense, but develops slowly. Healing can take weeks to months and requires patience. How the stress fracture occurs and how it becomes noticeable.

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Quick overview

Definition: A stress fracture is also called a stress fracture or march fracture. It usually happens in the foot (metatarsal bone).

Causes: The fracture occurs slowly due to overloading. The bone repeatedly experiences micro-injuries until it finally gives way.

Symptoms: A stress fracture is noticeable through pain. The overloaded area is often red, swollen and tender to touch.

Diagnosis: In addition to X-rays, MRI is primarily used for correct diagnosis.

How long sick? If the affected bone is protected, a stress fracture usually heals well.

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What is a stress fracture?

In contrast to a bone fracture, which can occur as a result of an accident, fall or violent blow, a stress fracture (stress fracture) develops slowly and gradually. Despite its hardness and stability, bone tissue is a very changeable substance. As part of natural bone remodeling, old bone material is constantly replaced by new.

A stress fracture of the metatarsal is the most common form. In addition to the metatarsal bone, the following can be affected:

  • Shin
  • fibula
  • Calcaneus
  • Knee area
  • femur
  • pool
  • Ribs

Possible causes of a stress fracture

Bones respond to mechanical stress. With regular sporting activity, they optimize their form to suit the load. However, if the bone substance is constantly subjected to heavy strain, the body can no longer maintain the repair processes. As a stress reaction to ongoing stress, water is retained and bone edema occurs. As a result of small injuries to the bone substance, a fracture ultimately occurs.

Medically, there are two types of stress fractures:

  • Stress fracture: It is a form of sports injury and is estimated to occur in ten percent of all sports injuries. People who play football or athletics are often affected. Risk factors for the fracture include overuse, unsuitable footwear and excessive training intensity.

  • Insufficiency fracture: The bone is damaged by foot misalignments, diseases such as osteoporosis or eating disorders, and a lack of vitamins, minerals or hormones. Certain medications or long periods of bed rest can also lead to bone loss and an insufficiency fracture.

Symptoms of a stress fracture

In the case of a stress fracture, the bone usually breaks rather than completely breaking through. The first symptoms are pain in the stress area, which can start slowly and gradually reduce resilience and ultimately prevent it altogether. A bruise or sprain is often thought of at this stage.

Possible symptoms:

  • diffuse pain
  • Pressure sensitivity
  • swelling
  • reddened skin

Diagnosis when a stress fracture is suspected

If you have unclear pain in the foot or lower leg area or in the hip or groin area, you should seek professional advice. When taking an anamnesis, doctors can find out whether there is a stress fracture. Targeted questions about physical activity as well as diet and lifestyle habits can help

An x-ray may not help because the fine cracks are barely visible at the beginning. An MRI scan provides final certainty and shows subtle damage to the bone structure.

In the past, skeletal scintigraphy was often used to diagnose stress fractures because it can show increased bone metabolism. However, because other bone diseases also show similar images, it is now only used if the MRI result is unclear or an MRI cannot be done.

A relatively new procedure is digital volume tomography (DVT), which quickly creates three-dimensional images with low radiation doses. However, the costs have not yet been covered by statutory health insurance companies. DVT is part of diagnostics in many sports medicine practices and is also often used for surgical planning.

Therapy of stress fractures

A stress fracture usually does not need to be splinted or casted; it needs rest to heal. How long patients should rest after a stress fracture of their foot, for example, depends on the extent of the damage. Depending on the findings, the protection can last several months. The bone can take a long time to fully recover and be stable again.

For athletes it can be a big challenge to have to forego training. However, in your own interest you should follow the doctor’s instructions. Light exercise as well as swimming and cycling with low training intensity are possible after a certain period of time, depending on the initial situation of the fracture.

Other treatment options for a stress fracture may include:

  • Crutches for relief
  • special support or relief shoes (orthoses)
  • orthopedic shoe insoles
  • orthopedic tapings
  • Painkillers, anti-inflammatory drugs
  • Drugs that stimulate bone metabolism
  • increased intake of vitamin D and calcium
  • Ultrasound treatments
  • acupuncture
  • physical therapy

In most cases, stress fractures heal completely with appropriate care. In the future, the amount of training should be reduced as much as possible.

Stress fracture: prognosis and how to prevent it

As a rule, a stress fracture heals well and without consequences, but you should then exercise with shock-absorbing shoes, pay attention to the surface and avoid hard floors when training if possible. A running analysis can reveal incorrect loading and help to avoid these in the future during movement. Once misalignments have been diagnosed, special orthopedic insoles counteract overloading in the foot area.

A stress fracture can be prevented by slowly increasing the amount of training you do, taking sufficient rest breaks and eating a balanced diet. The possibility of a stress fracture should be considered if pain occurs suddenly without a traumatic event. Persistent pain under stress should always be taken seriously and medically clarified at an early stage.

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