Stress Fractures
While many of us are very much familiar with the all-consuming pain that arises from a regular fracture that occurs when we break a bone, stress fractures occur gradually over time, with some people experiencing little to no symptoms in the early stages of a stress fracture.
Stress fractures develop when a bone is repetitively overloaded, meaning that the force applied to the bone from regular activity like exercise or walking exceeds the limit that the bone can safely handle, so tiny, hairline cracks form, starting a stress fracture.
What Are The Signs Of A Stress Fracture?
In the early stages of a stress fracture, there may be a dull ache or niggle, which gradually increases in severity as the stress fracture worsens over the following weeks or months. This makes stress fractures difficult to pinpoint and diagnose in the early stages, with many people unable to identify the moment or event that their pain started. Instead, patients describe to us an ache starting at the affected fracture site one day out of nowhere, and that the pain is worsened when they try to stand, walk or exercise.
The pain of a stress fracture is typically localised to the area of the bone where the fracture has occurred and may radiate up or down the bone. Stress fractures often occur in the lower limbs because of the impact forces and stress on these bones during physical activity and everyday life. Common sites of stress fractures in the feet and legs include the shin bone (tibia), the long bones of the feet (metatarsals) and the heel bone (calcaneus).
How Does A Stress Fracture Happen?
When a bone is repetitively placed under excess pressure and stress over a long period of time, a stress fracture can develop in that area. This may be from:
- Going too hard, too fast in physical activity and overloading areas like the shin bone
- Wearing poor of unsupportive footwear, which places extra strain on certain bones in the feet or legs
- Training on hard surfaces like concrete, meaning the bones are absorbing more forces
- A sudden increase in intensity or duration of high-impact physical activity
- A poor gait pattern or a poor training technique
- Poor foot posture and foot problems like bunions and joint deformities
- Decreased bone strength or density, including from conditions like osteoporosis
- Muscle weakness and imbalances that may alter foot posture and function
The Dreaded Black Line
It’s very important to treat stress fractures as early as possible. This is because stress fractures can continue to grow bigger over time if they’re not properly managed, and the larger a fracture, the more painful it is and longer it takes to treat.
One possible scenario that can occur when a regular stress fracture is ignored is that it may develop into a more serious and severe fracture of their shin bone (tibia), usually halfway down between the knee and ankle. It starts as a stress fracture, developing gradually over time, but progresses to a complete (or near-complete) fracture in a horizontal line across the bone. The gap created in the shin bone shows up black on an x-ray, hence the black line. It is ‘dreaded’ because it is more complicated to treat than a standard stress fracture and requires more effort than just giving the bone time to rest and heal while removing the source of the stress. In almost all cases, treatment will involve either removing all pressure from the leg using a moon boot or similar device, or surgically placing a rod through the bone to keep it connected, with the option of using a bone graft to stimulate healing. These ‘hard and fast’ treatment measures are needed as it is difficult for the body to create new bone to fill the gap naturally.
The dreaded black line often occurs from running and jumping sports, including gymnastics. While the onset of the pain is muted and is often presumed to be shin splints or a mild injury, seeking medical attention is delayed in the hopes that it will heal on its own, during which time the damage can worsen and progress.
Stress Fractures Treatment
If you’re experiencing pain and have the symptoms of a stress fracture, we may confirm your diagnosis with an x-ray. Bear in mind that it can take many weeks for a stress fracture to show up on an x-ray after it has occurred. Our podiatrists can refer you for your x-ray and discuss the results with you, whether it’s a stress fracture or something else.
In order to treat stress fractures effectively, we need to identify and address the cause – the repeated stress and pressure to the damaged bone. We’ll work with you to help the fracture heal effectively while helping prevent it from recurring in the future. This may mean:
- Using good, supportive and cushioning footwear to help reduce the forces and impact on the feet and legs
- Avoiding or adjusting any activities that are causing you pain and contributing to the fracture
- Using custom foot orthotics to help with any biomechanical or postural issues that may be contributing to your fracture
- Physical therapy if any muscle weakness or tightness may be contributing to your injury
- A moon boot or air walker if the fracture is severe and needs significant offloading
Can Stress Fractures Reoccur In The Future?
Without adequate care and future preventative treatment, there is a chance stress fractures can recur. Our podiatrists can help you to instigate preventative measures such as:
- Educating you about the role that your bone density may be playing in your stress fractures. Exercise, calcium and vitamin D from sunlight form a key part of maintaining a healthy bone density, but some people are prone to weaker bones due to their genetic makeup or medical conditions. You can discuss with your podiatrist whether it could be worthwhile requesting a bone density assessment with your medical provider, and supplements if your diet is insufficient
- Showing you how to choose supportive sports shoes with sufficient cushioning, and signs that they need replacing when they wear down
- Helping you combine low-impact physical activities with high-impact activities where possible, especially when changing your exercise routine. This is as a high-impact only strategy may increase your stress fracture risk
- Correct any problems and inefficiencies with your lower limb biomechanics, including foot posture and gait via gait retraining
I’m Concerned About A Stress Fracture, What Should I do?
Seeking treatment and support for any pain or niggles when they start is essential to ensuring any stress fractures are accurately investigated, diagnosed, and treated as soon as possible. If you’re concerned about a stress fracture, book in for an appointment with your podiatrist at your earliest convenience.
Frequently Asked Questions
How long does it take for a stress fracture to heal?
The healing time varies but can range from several weeks to a few months, depending on the location and severity of the fracture. Your podiatrist will be able to give you an estimate based on your unique symptoms and circumstances at your appointment, after a thorough investigation.
Can stress fractures be prevented?
Yes, preventive measures include gradually increasing training intensity, wearing appropriate footwear, maintaining good nutrition, and listening to your body for signs of overuse. If you already have an existing stress fracture, your podiatrist will help identify the likely causes and help you put preventative measures in place to reduce the likelihood of recurrence.
Do stress fractures always require surgery?
No, most stress fractures do not require surgery. Conservative treatments are typically effective, and surgical intervention may be necessary in rare cases.