A stress fracture is an incomplete break of the bone. "Fracture" is the medical term for "break". Stress fractures usually occur in the lesser metatarsal bones in the foot. The metatarsal bones are the long bones in the middle of the foot. The 2nd, 3rd and 4th metatarsals are the most commonly affected. The pain is usually sharp and develops suddenly, but it is not the result of a specific injury or trauma. Stress fractures are more commonly the result of overuse and repetitive stress. Pain comes on suddenly, with associated swelling and bruising on the top of the foot. Most people can't remember a specific injury or event. But, many can relate the event to walking in a new pair of shoes, starting a new activity or changing activities.
In the X-ray below, there is a small amount of bone growth on the inside of the 3rd metatarsal on the X-ray on the left. This is an example of a healing stress fracture. The bone growth surrounding the 2nd metatarsal on the X-ray on the right, is in response to the break in the bone. The bone growth stabilizing the fracture.
Initially, stress fractures do not show up on the X-ray. It may take four weeks before signs of the broken bone show up on the X-ray. This is because the incomplete break is difficult to see and visualization of the fracture only occurs when bone healing shows up on the X-ray.
The treatment depends on the area of the break. When the break is in the metatarsals and further towards the toes, then a rigid shoe for 4-6 weeks is the most common treatment. When the break is further back in the foot, a cast boot for 6-8 weeks and sometimes crutches are necessary.
See our blog on Surgical Repair of Stress Fractures in Dancers.
last updated 7/17/10
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