Stress Fracture Treatment

It is probably the advice that you least want to hear, but the best treatment for stress fractures of the foot is to take the weight off the feet, and to stop taking part in exercise, at least during the initial phase of recovery. As with any fracture or break, the bones must be given time to heal properly and rest is the best way to give the bones time to heal. The healing time of stress fractures is typically 6-12 weeks, although a full return to high impact sports may not be possible for up to 3 months. Treatment for stress fractures is typically rest, alongside medication to reduce swelling and pain and devices to make walking possible without causing further damage. Initially icing the affected area can be highly beneficial to ease pain and swelling.

Delayed Treatment Due to Delayed Diagnosis

A stress fracture may be suspected; however it may not be possible to confirm a diagnosis immediately, as stress fractures may not be noticeable in an x-ray until healing has commenced. This can take up to three weeks after the initial symptoms of a stress fracture are displayed. Delaying treatment means that there is a risk of the fracture developing further. When medical insurance or availability of testing does not permit an MRI or other more accurate imaging tests to be conducted, it is usually necessary to immobilize the foot and restrict weight bearing activity until a full diagnosis can be made and the best treatment of the stress fracture can be decided. The speed of recovery will greatly depend on the location of the stress fracture and its severity, and specific advice should be sought about a recovery plan and a return to exercise once a diagnosis has been confirmed.


Initial Treatment of Foot Stress Fractures

In the majority of cases, the treatment for stress fractures is rest together with a device to keep the foot immobilized and to offer assistance with ambulation. To help the healing process, a period of time on crutches can be highly beneficial. This can prevent the fracture from developing further and will give the bone time to heal. One problem which can happen during initial recovery from a stress fracture is that by altering the gait, excess force is shifted to other areas of the foot. When this happens, the it can have knock on effects, and can cause other foot problems to develop.

Casting the foot is usually not necessary, and may not be advantageous as such immobilization may cause the muscles to lose conditioning or the area to weaken making further injury more likely when weight bearing activity is resumed. A cast will severely limit activity and most active individuals will not want to lose body condition while the foot is casted. Since non weight bearing activity is possible while allowing the foot stress fracture time to heal, and activities can be undertaken which result in no pain, a cast is usually reserved only for stress fractures which are difficult to heal.

Top athletes will invariably be prescribed bone growth accelerators, although this is far from the norm for most patients. It is costly and deemed to be unnecessary in most cases. However the use of such treatments is likely to halve the recovery period from around a minimum of 6 weeks to 3 weeks, allowing athletes to resume training sooner and get back to their game in the shortest time frame.

The use of an air brace or other support may help to speed up healing during the initial phase of treatment. The use of rigid shoes or rigid shoe inserts can be highly beneficial to ensure that light exercise can be taken while the foot remains fairly immobile.

The associated pain from stress fractures can be controlled with anti-inflammatory pain medication such as Ibuprofen as an over the counter option, or with stronger prescription medication. While the drugs will certainly help they will not be able to counter the pain which is felt when pressure is placed on the feet by walking and running.

Returning to Weight Bearing Activity

The first stage of stress fracture treatment is rest from physical activity which places a stress on the affected area, but as soon as weight bearing is possible without pain the second phase of treatment can commence. Light weight bearing exercise is usually possible, provided that it does not cause pain or inflammation. Swimming is ideal for helping to improve conditioning in the muscles without weight bearing.

Muscle strengthening exercises can be of use to help develop muscle condition after a period of absence from weight bearing activity. Your doctor should be able to recommend exercises to complete while recovering to ensure conditioning of the muscles in the feet is not totally lost. These can be vital to help add strength to the feet to help prevent a re-occurrence of the injury.

After 2-3 weeks after a return to light physical activity, weight bearing exercise should then be possible. Any increase in activity needs to be implemented slowly with gradual increases in intensity, usually in the region of 10 to 20 percent increases every week.

Treatment of Stress Fractures of the Fifth Metatarsal, Navicular and Talus

Although the treatment of stress fractures does not usually require a cast, certain stress fractures can be difficult to heal naturally and totally immobilizing the foot may be recommended. Stress fractures of the navicular bone, talus and fifth metatarsal can benefit from a cast to facilitate healing. Stress fractures in these bones may not heal without casting, and poor blood supply will certainly make the healing process longer. It is not unusual for surgery to be recommended for these types of foot stress fracture to ensure proper union of the fractured bone.

Surgical Treatment of Stress Fractures

In the majority of cases, it is not necessary to undergo surgery to treat stress fractures. Provided that the bones are given time to heal properly and weight bearing is ceased initially, they do not need to be screwed in place in order for healing to take place. However there are exceptions, and stress fractures of the fifth metatarsal often require the bones to be fixed to facilitate healing. This is because the healing time is particularly slow due to limited blood supply in this part of the foot. Other slow healing stress fractures may also benefit from surgical correction.

Stress fracture surgery may be required if the break is severe and the fracture is unlikely to heal naturally. Athletes and sportsmen and women may also undergo surgery in an attempt to speed up the healing process to get back in the game more quickly.


References

  • William A. Romani et al (2002) – Mechanisms and Management of Stress Fractures in Physically Active Persons; J Athl Train; 37(3): 306–314
  • Barry P. Boden, MD and Daryl C. Osbahr (2000) – High-Risk Stress Fractures: Evaluation and Treatment; J. Am Ac Orthopaedic Surgeons
  • American Orthopedic Foot & Ankle Society – http://www.aofas.org/footcaremd/conditions/ailments-of-the-midfoot/Pages/Stress-Fractures.aspx
  • American Academy of Orthopedic Surgeons – http://orthoinfo.aaos.org/topic.cfm?topic=a00112
  • American Academy of Podiatric Sports Medicine