Can the pain in your foot be signaling a foot stress fracture?
I had a friend come to me recently with a complaint of foot pain and swelling that began after walking.
She denied injury such as falling or high impact activity. She reported pain along the top of the foot along
the “ball of her foot” in the front that was moderately severe with walking and weight bearing and was alleviated
with rest. She had been walking in flip flops a lot in the summer but other than that nothing unusual.
She reports taking Ibuprofen for pain but this was only minimally helpful.
The patient came into the office and x-ray with fluoroscopic guidance was performed of the foot with
focus on the ball of her foot through the joints called the metatarsals. There did not appear to be any
fracture or broken bones. She was instructed to stay off of the foot as much as possible; she was
prescribed Diclofenac, a strong prescription anti- inflammatory; and she was instructed to order a boot to
immobilize the foot. After several days the Diclofenac, while helpful, did not alleviate the pain with
weight bearing so an MRI was ordered. MRI report and images revealed a stress fracture of the second
metatarsal.
The friend had questions about the fracture that are commonly asked with this type of injury.
What is a Foot Stress Fracture?
Stress Fractures are microscopic fractures that occur in bones of the lower extremities usually
due to repetitive stress. This can be seen in high impact exercise such as runners and other
athletes, army recruits but can also occur in bones where more impact is placed on the bone
and results in a fatigue type of fracture due to excessive stress with walking.
Women are at higher risk for stress fractures, other contributing risk factors include
osteoporosis, history of smoking, hormonal imbalance, sudden increase in activity level and
poorly supportive and fitting footwear to name a few.
Stats about Stress Fractures
Stress fractures account for about 20% of all sports injuries, the most common site are the
metatarsals of the foot, the second most common is the pelvis particularly in women. Stress
fractures can also develop in the lower leg, upper leg (femur), and the spine.
Signs and Symptoms of a Stress Fracture
Like my friend, most patient’s present with insidious onset of pain in the area, there may be
some mild swelling and local tenderness to the area, pain with weight bearing. Pain is usually
progressive and does not resolve with anti inflammatory medications.
Diagnosing a Foot Stress Fracture
Typically an Xray is performed of the area to rule out generalized fracture, there may be some
bony changes but generally xrays are negative in many cases of stress fracture. Persistent pain
necessitates use of MRI scan to further identify a stress fracture.
Treatment of a Foot Stress Fracture
The most common stress fracture in the foot is of the metatarsals 2nd -4th. Rest with limited
weight bearing or wearing a boot for immobilization for 4-6 weeks is the standard. Return to
activity after this time frame should progress when pain has resolved. When returning to
weight bearing in regular footwear it is important to wear supportive shoes with proper cushion
and to consider supplementation with Vitamin D and Calcium.
Proper Foot Support
ALINE prescriptive insoles were developed after twenty years of research into the way feet work. Custom products capture the foot in one shape, standing still. The problem is that for active people, standing still is not how they live. ALINE’s suspension zones allow the hundreds of moving bones, ligaments, and tendons to move the way nature intended, while still being supported.
- Support lower extremity alignment from foot to hip
- Relieve pain caused by plantar fasciitis, neuromas, and shin splints
- Restore natural barefoot function with sufficient support
- Help alleviate low back discomfort
- Optimize muscle firing and performance
CHARM offers a personalized static and dynamic assessment plus a proper fitting of ALINE in office.
- https://www.ncbi.nlm.nih.gov/books/NBK554538/
- https://journals.lww.com/acsm-csmr/fulltext/2017/01000/stress_fractures.5.aspx
Michelle Hall
PA-CPhysician Assistant
