What is a stress fracture?
A stress fracture is a crack in a bone, often caused by high impact, repetitive sports such as long distance running, or basketball. They occur most frequently in the foot, and are very painful.
Fortunately most stress fractures get better with rest and the appropriate treatment. Occasionally severe stress fractures do not get better on their own and may need surgical treatment. In these cases full recovery can take months or years.
How do we treat stress fractures at the Mansfield Clinic?
The priority when someone presents with symptoms suggestive of a stress fracture is to make the diagnosis. Dr Allfree has a specialist interest in Sports Medicine and has experience in diagnosis of stress fractures. If investigations are required, these can be arranged.
Once the diagnosis has been made, appropriate advice will be given.
There are many different sports that can increase the risk of stress fractures. In particular, activities that involve running and jumping can cause fractures in the feet. They are most common in the metatarsal bones of the foot.
Stress fractures are more likely to develop in people who have just started a new exercise or who have stepped up the intensity of their exercise regime too quickly. When the muscles aren't strong enough, they get tired easily and cannot support the bones as well as they should. Increased pressure is then transferred on to the bones, and this can lead to a fracture.
Stress fractures are more common in women, especially if they do not have regular menstrual cycles. This is due to a reduction in oestrogen which can cause the bones to be brittle. Teenagers are also at greater risk because their bones aren't fully hardened.
Any anatomical abnormalities, such as fallen arches in the feet, can distribute stress unequally through the feet and legs, increasing the risk of stress fractures. Also poor-quality equipment such as worn-out running shoes can have the same effect.
Stress fractures can recur. About 60% of people who have a stress fracture have had one before.
Stress fractures usually present with a dull pain around the site of the fracture. The pain worsens while exercising, walking or standing. There may also be swelling in the area of the fracture.
The most important part of managing a patient with a stress fracture is making the correct diagnosis, and for this a thorough physical examination is very important. Dr Allfree has a specialist interest in sport-related injuries, and has experience in seeing patients with stress fractures.
Even X-rays can fail to detect stress fractures, particularly if they are taken too soon after the injury, and it is not unusual for patients to be reassured that there is no fracture, when actually there is. Sometimes an MRI scan, or a bone scan may be needed to make the diagnosis for certain.
The initial treatment for a stress fracture is to elevate the extremity and rest to allow the bone to heal itself. Ice applied to the affected area for the initial 24 to 48 hours is helpful. Custom made ice packs are available from the Mansfield Clinic. Painkillers such as paracetamol or ibuprofen may help. Depending on which bone is involved, a splint or cast to immobilise the affected area may be needed.
When the swelling decreases, you can begin partially putting weight on the area. In some cases, crutches or a walking stick is necessary. Usually you can begin full weight bearing about two weeks after the symptoms started. Weight bearing at this stage actually helps the healing process.
For the next six to eight weeks you must avoid the activity that caused the stress fracture in the first place. If you exercise too soon, you will delay the healing process, or even cause further damage that may never heal properly.
When you are ready to return to the activity, you must do it slowly. If you rush back to sport too soon, you could injure yourself again. Dr Allfree will advise you accordingly.
Very severe stress fractures that won't heal on their own may need surgical treatment. In these cases full recovery can take months or years. If you need a surgical referral, Dr Allfree will be able to make the appropriate arrangements.