DEAR DOCTOR K:
What is a stress fracture?
A patient of mine once asked me the same question, but with a twist: “In the emergency room they said I had a stress fracture. That’s ridiculous, right? I mean, they’re blaming stress for causing nearly every symptom these days. But how can stress cause a bone to break?”
It’s not emotional or mental “stress” that the word refers to in a stress fracture. It is stress — unusual physical pressure — placed on a bone that causes it to break. And the break typically does not separate the two ends of the bone. The X-ray, CT scan or MRI scan often shows no abnormality in the shape of the bone. Instead, there is a hairline crack inside the bone.
In young people, stress fractures can result from overexertion or prolonged high-impact exercise, such as running or tennis. But they also occur in middle-aged or elderly people, especially women, with thinning bones. These people may develop stress fractures even as a result of normal daily activities, such as walking.
In the feet, stress fractures most often occur in the metatarsal bones, the long bones leading to the toes. But they can also occur in other parts of the body.
All fractures, including stress fractures, require immediate attention. An untreated fracture might not heal properly and could result in deformity, persistent pain or both.
One warning sign of a stress fracture is difficulty walking. Don’t be fooled, however. It’s sometimes possible to walk on a broken foot. Check to see whether you have any pain or tenderness directly over the bone when you touch it lightly. Such focal pain may indicate a fracture, especially if it continues after you’ve rested briefly and followed the RICE (rest, ice, compression, elevation) regimen.
Other symptoms of a stress fracture include bruising and possible redness and swelling. Whatever you do, don’t continue exercising if you have localized pain over a bone. You might break it completely.
If you suspect that you have a stress fracture, see your doctor. He or she may start by ordering an X-ray. However, it can take two weeks for evidence of a stress fracture to appear on an X-ray, and some stress fractures never show up on one. Your doctor may have to diagnose the condition by feeling the area, or ordering other imaging tests such as a bone scan or an MRI.
If you do have a stress fracture, your doctor will probably recommend rest. He or she will likely also prescribe some type of immobilizing device, such as a special hard-soled shoe or a fracture boot. Typically, stress fractures heal within four to six weeks.
The best way to prevent a stress fracture is to avoid sudden increases in activity or exercise. Instead, build up your exercise regimen gradually. Wear well-cushioned shoes to reduce the impact on your feet. Warm up before you exercise. Limber muscles allow better joint motion and flexibility, which in turn help cushion the impact on your bones.