Road to recovery – the fastest way to come back from stress fractures


Road to recovery – the fastest way to come back from stress fractures


As training changes and intensifies, runners and other athletes become more susceptible to stress fractures in their feet.

What is a Stress Fracture?

As defined by Ortho Info, a stress fracture is severe bruising within a bone or a small crack in a bone and is often caused by repetitive activity and overuse of the bone. This type of injury frequently occurs in runners or athletes who take part in sports involving running, such as basketball or soccer.

Stress fractures often occur in the weight-bearing bones of the feet and lower leg due to the repetitive impacts they are forced to absorb when jumping, running or walking. As is also the case with muscle, bone breaks down and builds up when subjected to the stresses of running. When the body is unable to build up the bone fast enough in response to increased training, stress fractures can occur.

Factors that Contribute to Stress Fractures

In some cases, athletes are predisposed to stress fractures.

  • Previous stress fractures. According to Runner’s World, 60 percent of athletes who have a stress fracture have had one before.
  • Skeletal alignment and a low bone remodeling rate. These factors cannot be changed and leave athletes with these conditions at risk of stress fractures.
  • Being female. Female athletes are at a higher risk of sustaining stress fractures than male athletes. This can be attributed to amenorrhea and osteoporosis which can even occur in teenage girls. It is important to identify these conditions as soon as possible as bone density loss may be permanent.
  • Poor training. This also includes wearing incorrect footwear, as well as running on uneven surfaces.

Symptoms of Stress Fractures

When experiencing the following, it is important to consult a physician.

  • Bone tenderness not related to trauma
  • Pain that does not reduce when resting
  • Swelling and redness outside the ankle or on top of the foot
  • Tenderness at the site of the fracture

Ignoring symptoms of a stress fracture in the foot will only make the injury worse during weight-bearing activity and could result in the bone breaking completely.

If for some reason the athlete is unable to set up an immediate appointment with a physician, they can begin the treatment process by doing the following (RICE):

  • Athletes should avoid putting weight on the injured foot. If bearing weight on the foot cannot be avoided, it is important that the athlete wear an extremely supportive shoe with a thick sole, instead of thin slippers.
  • In order to keep the swelling down, ice should be applied immediately after the injury and several times a day for 20 minutes at a time, and never directly on the skin.
  • Lightly wrapping the area in a soft bandage can help prevent additional swelling.
  • When resting, the foot should be elevated higher than the heart.

Nonsteroidal pain killers can provide relief from pain until consultation with a physician.

Treatment of Stress Fractures in Athletes

This is often a challenging task. Athletes who compete on any kind of professional level have limited timeframes to heal and get back to training. This means that athletes are often hoping to shorten recovery time by any means possible, and get back to training as soon as is safe for them.

Once the physician has ordered tests such as an X-ray, an MRI or bone scan to confirm the diagnosis, treatment can begin.

If diagnosed early, stress fractures will generally heal given enough time to rest.

Depending on the severity of the stress fracture, the athlete may require either nonsurgical treatment, or surgical treatment.

Nonsurgical treatment

In addition to the RICE procedure mentioned above, the doctor may prescribe anti-inflammatory pain killers. Doctors often advise the use of crutches to keep weight off the injured foot.

At the doctor’s discretion, the athlete may be allowed to carry out modified activities that place less stress on the leg and foot. Good alternative exercise examples are swimming and cycling if the athlete wishes to keep fit while healing.

Some stress fractures take longer to heal and may require a cast. The cast will help keep the foot immobile, resulting in uninterrupted healing.

Surgical treatment

Severe stress fractures on the foot may require surgical intervention. This often involves inserting screws, pins or plates that hold the bones (particularly the small bones) of the foot together while it heals.

Recovering from Stress Fractures in the Foot

It generally takes 6 to 8 weeks for a stress fracture to heal. A more serious injury may require more time. During this time, running or repetitive weight-bearing activities must be avoided. Returning to these activities too soon can put the athlete at risk for more severe and longer-to-heal injuries. It could even result in the stress fracture never healing properly and the athlete will be unable to return to their sport of choice.

Once the patient is pain-free, the doctor will conduct another X-ray or CT scan to determine if the fracture has healed or not. Only then will the doctor advise a slow and gradual return to activity with alternating days of rest in between. It is important to give the bone time to heal properly and adjust to the physical demands being placed upon it.

As the bone heals, intensity, duration and frequency of activities can be increased.

Preventing Future Stress Fractures

Diet plays a very important role in prevention. A diet rich in calcium, vitamin D and magnesium will help improve bone strength.

Proper footwear is also essential for proper absorption of shock and prevention of injury.

New activities should be eased into, to give the body ample time to adjust. Strength training exercises should also be incorporated in order to prevent loss of bone density and early muscle fatigue.

If any pain or swelling returns, the athlete should stop all activity and rest for a few days. If the problem persists, a visit to the doctor may be in order.

With all injuries it is important to remember that prevention is better than cure, and adequate healing time – no matter how frustrating – is essential in avoiding future, more serious injuries.

Dr. Donald Stran

Dr. Donald C. Stran has practiced in the community since 1987. He is Board Certified and is a Fellow of the American College of Foot and Ankle Surgery. He is currently a teaching physician with the St. Joseph’s Medical Center podiatric residency program.

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