A stress fracture is a small crack in the bone that often develop from overuse rather than from a direct trauma to the bone. Most stress fractures develop in the weight bearing bones of the foot and lower leg. The most common sites for stress fractures are the second and third metatarsals, the calcaneus (heel bone), the distal fibula (outer bone of the lower leg) or the navicular (middle part of the mid foot). Stress fractures usually occur when you increase your activity by frequency, duration and/or intensity. Osteoporosis can also contribute to the development of stress fractures.
Stress fractures can be clinically diagnosed by observing swelling over the fractured bones, tenderness to touch at the site of the fracture and reports that pain becomes more painful when increasing activity. X-rays will almost certainly be required initially, however, stress fractures can be hard to see on x-rays and a further MRI (Magnetic Resonance Imaging) or nuclear medicine scan may be required.
Orthotic treatment for stress fractures will vary depending on the exact location of the fracture. A CAM walker may be required if the fracture involves the ankle. With stress fractures of the metatarsals or navicular, a carbon fibre footplate and custom made foot orthoses may be fitted. The carbon fibre footplate immobilises the fracture site while the custom foot orthoses will support the bones of the foot during weight bearing.
Rest or at least reduced activity in essential in healing a stress fracture. In severe cases, when the fractures don’t heal using conservative management, surgery may be required. Pins, screws or plates may be used to internally fix and immobilise the site of the fracture. It is important to note there are many risks associated with surgery, and conservative management should always be trialed prior to committing to surgery.