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Stress Fractures

Stress fractures are one of the most common sports injuries, with women affected more often than men. They are small cracks in the bone, caused by overuse. Fractures happen when the muscles, which become tired, are no longer able to absorb the shock of an impact caused by a repeated movement. Stress fractures often occur in bones that take the most weight, for example the second and third metatarsals in the foot (these are thinner than the first metatarsal and take the greatest impact when you walk or run). Stress fractures can also affect the calcaneus (heel), fibula (outer bone of the lower leg and ankle), talus (in the ankle joint) and navicular (on top of the midfoot).

Which activities can cause stress fractures in the foot and ankle?

  • Dancers are more likely to have stress fractures in the navicular or metatarsal bones
  • Walkers and runners can have stress fractures in the metatarsal and calcaneal bones
  • Stress fractures in the heel area can also be associated with tibial and femoral neck stress fractures. These fractures further up the leg are very serious because, if they develop into a complete fracture or the bones become misaligned, this can lead to arthritis that progresses very fast. If the bone in the femoral head dies, this mean you will need to have a total hip replacement

What causes stress fractures?

Stress fractures can develop over time. New bone is constantly developing, replacing older bone. But if the repeated activity is too intense, it breaks down the older bone too fast, before new bone can grow so bones become weaker and more likely to fracture. Causes of stress fractures include:

  • Suddenly increasing the intensity of an activity – doing too much too soon – especially on a hard surface
  • Not wearing the right shoes or using the right equipment for a sport
  • Increasing activity levels (taking part in sport more frequently than before)
  • Having an abnormal foot posture or movement
  • Having osteoporosis or a hormone condition that affects the density of your bones
  • Women who have irregular periods are more likely to be affected, due to reduced oestrogen. (This is because oestrogen normally helps to strengthen bones)
  • High impact sports including running, jumping, or dancing can make an injury more likely

What are the signs of a stress fracture?

The most common sign is having pain when you exercise, which goes away when you rest.

How are stress fractures diagnosed?

During your first appointment, you’ll have an opportunity to discuss your symptoms with Mr Heidari, who will be able to advise you on the best course of treatment. He may also arrange for you to have X-rays along with an MRI scan to show the injury in greater detail and back up the diagnosis.

What does treatment involve?

It’s important to stop the activity that has caused the fracture and to rest as much as possible for around eight weeks while the fracture heals. This is followed up with regular MRI scans to check that the fracture is healing. If you don’t rest, and carry on as normal, this can lead to more stress fractures which may not heal as easily. Mr Heidari may also recommend that you wear shoe inserts or braces while the fracture heals.

Athletes can be offered surgery to help them return to their sport as quickly as possible, especially if they have a medial malleolus fracture (the inside of the tibia) or a 5th metatarsal fracture.

Avoiding further stress fractures

Following any treatment, it’s important to take things easy and return gradually to your training, without putting too much stress on your bones.

In order to avoid having more stress fractures in the future, Mr Heidari may advise you to modify your training goals and avoid pushing yourself too hard or too fast. As a general guide, you should be increasing your training intensity by a maximum of 10% each week. It can also be a good idea to vary your training programme and make sure you use the right equipment for your sport, especially the correct shoes.

This information is written as a guide to your treatment but it is not intended to replace the advice of your doctor. Please contact us for advice if you are worried about any aspect of your health or recovery.