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Stress Fractures

At the start of track and field season for high school, I reminisce of the second reason that I had to visit the podiatrist: a stress fracture. It was the start of the track season of my sophomore year of high school. I had earned enough money to buy a new pair of shoes and I was ready to break my personal best records and make the relay team for the 4x800m race. What I didn’t know was that the racing flat style of shoe I bought did not have enough support for the higher mileage of running on pavement. My feet started to hurt, but I looked at it as part of the gig. I reasoned that 5-6 miles per day would do that. Soon, the pain became too much. I still remember the day and the workout that ended the early part of the season. We were running our “stair-ladders” work out. We would run the 100 steps up to the track, then a 200 meter sprint, followed by the stairs and a 400 meter sprint, adding 200 meters per “rung” up to 800 and then back down again. I couldn’t make it past the 800 meters. The foot pain was too sharp and intense.

I went to my podiatrist the next day, diagnosis: metatarsal stress fracture. I was told that the increased activity and stress of running on pavement over the previous 2 weeks had weakened my bone to the point that it started to break. I found myself in a CAM (Controlled Ankle Motion Walker) boot for 6 weeks and had to slowly return to activity.

What are Stress Fractures?

Stress fractures are small hairline cracks in a bone that develop over time due to repetitive activity. The most common sites for stress fractures in the foot are the metatarsal bones (see image). They can be caused by overtraining or overuse, as well as poor quality shoe gear among other factors. In my case, it was a combination of both.

If you have osteoporosis or another condition that weakens the bones, a stress fracture could develop from normal activities.

The most common symptoms are a painful throbbing and achiness that develops gradually and increases with weight bearing activity and decreases with rest. Swelling and tenderness to touch and pressure around an area are also symptoms consistent with stress fractures.

Diagnosis and Treatment

The stress fracture itself won’t appear on x-ray for about 2 weeks. Evidence of healing appears as a “bony callous.” The bone heals by laying down new bone.
If you have recently increased your activity and think you might have a stress fracture, see your podiatrist soon for the appropriate treatment. Early non-weight bearing and immobilization in a CAM boot, followed by weight bearing as tolerated until you can return to activity. This process usually takes about 6-8 weeks depending on the patient.