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Dr. Marian Wymore

Q: I took up walking 30 minutes per day on horse trails to improve my blood pressure. I was doing fine until I took a long vacation and walked an hour or two a day on concrete roads. I’ve been having pain during my daily walk ever since. Now my foot’s a bit swollen, and I have the pain even when I’m just standing.

A: It’s possible that you’ve developed a stress fracture.

Stress fractures are repetitive overuse injuries of bone than occur gradually versus acute fractures that occur with a single traumatic injury.

A stress fracture can occur if you increase the duration, frequency, or intensity of a sport or activity too quickly, and overwhelm the ability of your bones to remodel themselves normally. Usually, bones are in a constant state of repairing themselves by replacing old bone and laying down new bone.

If you place too much of a load on your bones and they don’t have adequate time to remodel themselves, it weakens your bones and painful, tiny cracks may start to appear. These cracks can get worse with continued activity.

You were at risk for a stress fracture because you more than doubled your mileage suddenly, changed from dirt horse trails to a harder walking surface, and didn’t rest much between walks.

Did you increase the speed or intensity? Was your footwear new, adequately cushioned and supportive, or old and worn out? Other risk factors for stress fractures may include your age, sex and weight.

Stress fractures occur more often in women, especially if you have osteoporosis, poor nutrition or anorexia/bulimia, low Vit D levels, or obesity. Weak bones fracture more easily. Weight is a factor because when walking, running, or jumping, the load on your bones and joints is multiplied by four to twelve times your weight.

Stress fractures are one of the most common sports injuries. The bones that are susceptible to stress fractures vary by the type of sport or activity you are doing.

Some of the most common sports that cause stress fractures are running (and other track and field events that include running and jumping), basketball, gymnastics, tennis, and dancing. If you have weak muscles, bunions, flat or high arched feet, or other musculoskeletal issues that affect your body’s alignment, this may also increase your risk of stress fractures.

The most common stress fractures occur in the weight bearing bones of the feet, lower leg, thigh and pelvis. The long bones that connect the toes to the midfoot (metatarsals), the navicular (medial side of the midfoot), the calcaneus (heel bone), the talus (ankle joint), the tibia (shin bone) and fibula (lateral lower leg) are the most common sites. The femur bone (thigh), the pubic rami and sacrum (pelvis) and the lumbar spine are less commonly involved.

A physical exam may reveal tenderness and swelling over the painful area. But X-rays are often normal, at least initially.

A stress fracture may eventually become large enough to appear. Changes that demonstrate healing, called “callouses,” may show up on X-ray several weeks later. It generally takes 6-8 weeks (or longer) for a stress fracture to heal depending on where it is, the severity, and whether you rest it or not. An MRI or CT scan is a more accurate way to diagnose a stress fracture.

If your injury is relatively new, you can try rest, ice, compression and elevation acutely.

If no contraindications, you can try non-steroidal anti-inflammatory drugs as needed. Rest the area until released by your doctor or physical therapist, especially from the activity that caused the fracture.

Cycling or swimming might be acceptable alternative activities while you’re recovering. Return to your sport gradually and modify your training schedule. Don’t resume too quickly and risk reinjury, non-union, or chronic pain. Ask your doctor about bracing, taping, or shoe inserts.  Some fractures require cast boots, crutches, or surgery (if displaced or doesn’t heal).

Preventing stress fractures is best.

Cross-train (alternating different activities to avoid over-use), and gradually build up the duration, intensity, and frequency of your workouts, especially if returning to a sport after a long break or starting an activity for the first time.

A healthy, nutritious diet is important to help prevent stress fractures. Wear appropriate footwear for your activity (such as running shoes for running) that are new and have adequate support. Do muscle conditioning and strength training exercises. Treat underlying risk factors like osteoporosis or muscle imbalances. Use proper technique.

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