In the mid-nineteenth century, stress fractures were first reported in military personnel as “march foot.” Foot pain swelling were used to diagnose it in military recruits. Athletes military recruits are frequently injured stress fractures, also known as fatigue fractures. Lower extremity injuries are more common than upper extremity injuries. Patients who present with tenderness or edema following a recent increase in activity or repeated activity with limited rest should be evaluated for stress fractures.
Stress fractures are a type of bone overuse injury. The bones in the body are constantly changing as a result of the workload placed on them, there is a constant turnover of cells as bone acts to repair itself. The greater the load placed on the bone; the more likely calcium will be deposited at that location. The less a bone is used, the less calcium it can contain. If the stress of repetitive loads overwhelms the bone’s ability to repair itself, small cracks can form within the bone structure.
This is particularly noticeable in the bones of the foot, leg, pelvis. The forces generated walking, running, jumping must be absorbed these bones. Each step can generate up to 12 times the body’s weight, the bones, joints, muscles, ligaments must cushion the body against that force.
Bone is normally in homeostasis (homeo = same + stasis = standing still), which means that the natural turnover of bone cells is balanced between osteoclast activity (bone breakdown) osteoblast activity (bone formation). When bone is stressed, it suffers microscopic damage. Osteoclast cells are activated, causing bone absorption, the injured site is weakened. If there is a long period of time between injuries, osteoblast cells produce more bone cells to protect the damaged area. If the osteoblasts do not have enough time to produce new bone cells in the injured area, the microfractures can join together to form a large enough area to cause a stress fracture.
Sign Symptoms
A stress fracture can cause pain swelling, especially when weight is placed on the injured bone. Plain X-rays may appear normal in many cases. Pain is the most common symptom of a broken bone. The pain usually starts near the end of an activity goes away with rest, can persist throughout the night. The pain is consistent with little activity; during the night, it will become persistent with little activity.
If the stress fracture is not recognized or the symptoms are ignored, the pain will start earlier during the activity or exercise will last even after the activity or exercise is completed. Localized swelling at the site of injury is possible, as spot tenderness if the area is touched.
If the stress on the compromised bone area continues, the microscopic damage in the area worsens, the bone’s integrity can be completely disrupted, resulting in a fracture visible on X-rays.
The metatarsal bones are the most commonly affected stress fractures in the foot ankle. They are also common in the calcaneus (heel), fibula (the outer bone of the lower leg ankle), talus (the lower bone in the ankle joint), sesamoids (two small bones associated with the tendons of the big toe), navicular (a bone on the top of the midfoot).
Special attention should be paid to stress fractures at the base of the fifth metatarsal. Sir Robert Jones first described this injury in the early 1900s, it has since been referred to as a Jones fracture. This injury may manifest as pain on the outside of the midfoot, with or without acute injury. It is especially common in elite athletes. Stress fractures of the fifth metatarsal base are difficult to treat because the body’s blood supply to this area is inadequate, causing healing to take longer.
What to Do Next
Stress fractures develop over time, it may be difficult to determine when the initial injury occurred. Seeking medical attention is advised if the pain persists even in the absence of activity or if it worsens. If rest, ice, elevation do not relieve the pain, it is time to seek medical attention. Home care, as with most orthopedic injuries, begins with RICE protocol.
RICE is an acronym that stands for rest, ice, compression, elevation.
- Rest. Avoid activities that require you to put weight on your foot. If you must bear weight for any reason, wear a shoe that is very supportive. A cork sandal with a thick sole is preferable to a thin slipper. Make an effort to pay attention to your body. If certain positions or activities aggravate your pain, this is your body’s way of telling you that you’re putting too much strain on the injured area.
- Ice. To reduce swelling, apply ice immediately after the injury. Several times a day, apply cold packs for 20 minutes at a time. Avoid putting ice directly on your skin.
- Compression. Wrap the area lightly in a soft bandage to prevent further swelling.
- Elevation. Rest with your foot raised higher than your heart as much as possible.
With stress fractures, it may also be beneficial to limit or discontinue the activity that caused the injury until healing has occurred. People frequently prolong their recovery period returning to the activity that caused the injury too soon without allowing the body to fully heal.
What Treatment to Expect
The key to the initial treatment of a stress fracture is rest. To help rest the injured area limit the amount of weight-bearing allowed, a walking boot or brace, as well as a cast or crutches, may be required. Healing time may range from 4 to 12 weeks, depending on the bone involved, before gradually increasing activity levels can be resumed. Refraining from high-impact activities for a period of time is critical to recovering from a stress fracture in the foot or ankle. Returning to activity too soon not only delays healing but also increases the risk of a complete fracture. If a complete fracture occurs, recovery return to activities will take much longer. Doctor-prescribed medications may be beneficial in reducing inflammation pain.
Prevention is the best treatment for a stress fracture. Maintaining good bone health density aids in the prevention of all bone fractures. Wearing well-supported shoes that are appropriate for the activity will assist in managing the forces placed on the foot leg while walking, running, jumping. Flexibility muscle strength also aid in the support of the feet legs.
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