Stress Fractures of the Foot
A foot stress fracture is a common overuse injury most frequently seen in highly active individuals such as runners, athletes and sportsmen and women who play high impact sports. However foot stress fractures are not confined to this group and anyone can suffer from a foot stress fracture, including people who lead a largely sedentary lifestyle. The foot is the most common location for stress fractures to develop, with these tiny cracks usually affecting the metatarsals (the long bones in the feet) and the heel. The ankles, hips and pelvis are also relatively common locations for stress fractures to develop.
What Are Foot Stress Fractures?
Stress fractures are tiny cracks which usually form in weight bearing bones in response to repeated force, although they can form due to a single traumatic event such as an awkward landing or a crushing injury. A fracture may sound like a full break in a bone, but a stress fracture is rarely so severe. The cracks are usually so small that they may not even be picked up by an X-Ray, but over time they will develop further and can lead to a full fracture of the foot forming if exercise is continued and rest is not sought. Foot stress fractures may occur singularly or multiple stress fractures can form, especially when bones are weakened due to osteoporosis or vitamin D and calcium deficiencies.
What Causes Foot Stress Fractures?
These hairline cracks are most commonly caused from partaking in high impact sports, over-training, or undertaking activities to which the body has not had time to become conditioned. Muscle fatigue and over exertion are key factors which can contribute to the formation of these small fractures in the bones of the feet. Over long exercise sessions and when frequent exercise is undertaken without a suitable rest period, the muscles of the feet can easily get fatigued. Without the musculature, tendons and ligaments working at full capacity the bones of the foot become subjected to unnatural pressures and repeated forces can lead to these fractures developing. These fractures are not necessarily caused by a heavy footfall and can form over time in response to relatively small stresses. Footwear choice is a major factor in the development of stress fractures in the foot, especially athletic shoes which are not replaced frequently as the midsoles wear down.
Who is Most at Risk of Developing a Stress Fracture in the Foot?
People who partake in high impact sports such as running, gymnastics, football, basketball and tennis are most likely to suffer from this type of painful foot problem, as the forces acting on the feet are greater in these activities. However, any sporting activity or exercise regime can contribute to the formation of stress fractures in the foot. It is not the sport which is the problem in most cases, but most commonly caused when the feet are not warmed up or the muscles are not conditioned properly. Runners may well have the cardiovascular fitness to push past the pain barrier and increase the length of a run, but the body is only as good as the weakest link which is commonly the feet. When the duration, frequency or intensity of exercise is increased suddenly, the feet are more likely to succumb to stress fractures.
High impact sports tend to have a higher proportion of male participants; however stress fractures in the foot are more likely to be suffered by women. There are a number of factors which can increase the risk of women developing foot stress fractures, with the most common cause being osteoporosis. Osteoporosis predominantly affects older women, but it can strike at any age and teenage girls are particularly susceptible especially those who partake in sports such as gymnastics.
The teenage years are an important time for the formation of strong and healthy bones, and poor nutrition, low vitamin D intake and low levels of dietary calcium can all play a part in early onset osteoporosis. This in turn caused the bones to become brittle, and less able to cope with the normal forces during exercise. Although a stress fracture of the foot in itself can be painful and frustrating, it is not unusual for these tiny fractures to indicate that there is an underlying health problem such as a bone weakening disease. The diagnosis of a stress fracture should therefore warrant further medical tests to be undertaken to find the root cause of the problem. Only when the root cause is identified can action be taken to prevent further stress fractures forming.
Teenage Girls and Stress Fractures of the Foot
Although teenage boys can develop brittle bones from a lack of dietary calcium or low vitamin D levels, it is teenage girls who are at a higher risk of developing foot stress fractures. There are three main contributory factors which are grouped together as the Female Athlete Triad, due to the fact that they frequently occur together. The first element is an eating disorder such as anorexia and bulimia. Although these two eating disorders are extremes, the avoidance of certain foodstuffs due to fat content can increase the likelihood of developing stress fractures in the feet. The second component of the triad is amenorrhea (irregular periods) with the final aspect being osteoporosis. The first two elements contribute to the latter, and it is osteoporosis which makes stress fractures more likely, especially in female athletes and exercise enthusiasts. The Female Athlete Triad is discussed further here.
Where do Foot Stress Fractures Most Commonly Occur?
The most common locations of a stress fracture foot are the second and third metatarsals which run from the midfoot down to the base of the toes, the navicular bone in the midfoot and the calcaneus or heel bone. Stress fractures of the foot can be painful, especially on weight bearing and during exercise, with the pain usually subsiding with rest. Stress fractures can be accompanied with bruising and swelling, with the location of the fracture usually being sensitive to the touch.
How are Stress Fractures of the Foot Diagnosed?
A foot stress fracture can be inferred from a case history, when the pain started, the activity which was being undertaken at the time, whether the patient partakes in sports and exercise or there are signs of malnutrition, eating disorders or if the patient has not started menstruating or periods are irregular. An examination of the foot will also be necessary to determine the exact location of the pain, whether there is any swelling and any other symptoms which are accompanying the foot pain. An X-Ray may be recommended to confirm the diagnosis and to rule out a full bone fracture. A bone scan is a more reliable method of confirming a diagnosis as stress fractures may be too small to be seen clearly on an X-Ray.
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