Stress Fracture – Leg and Foot

The leg consists of two primary bones: the tibia, which is the larger shinbone, and the fibula, a thinner bone located on the outer side. Stress fractures frequently occur in the fibula and certain bones in the foot, including the heel (calcaneus), midfoot (navicular bone), and the second and third metatarsals, the long bones connecting the toes.

Stress fractures are primarily caused by high-impact activities, overuse, or incorrect form during physical activities. The repetitive stress on the bones may prevent them from healing properly. Conditions like osteoporosis can further weaken bones, increasing the risk of fractures. Individuals who engage in intense exercise regimens without sufficient preparation, or who experience significant fatigue, are particularly vulnerable. Dancers, military trainees, and athletes involved in high-impact sports face higher risks due to activities that involve jumping, running, and marching. Additionally, factors such as gender (with women at greater risk due to hormonal influences), tall stature, leg length discrepancies, smoking, and genetic predisposition can contribute to the likelihood of developing stress fractures.

The primary symptom of a stress fracture is a gradual onset of pain that worsens with activity. Although resting may alleviate discomfort, pain during the night is common. Swelling, bruising, or tenderness may appear on the top of the foot or on the outer ankle.

If you suspect a stress fracture, minimizing weight on the affected foot is important until you can see a doctor. Diagnosis involves a review of your medical history and a physical examination, during which you should inform your doctor of any activities that may have contributed to the injury. Imaging tests such as X-rays or bone scans can confirm the diagnosis; while X-rays may not show fractures immediately, bone scans are more sensitive. MRI scans are also effective in identifying stress fractures not visible on standard X-rays.

The cornerstone of treatment for most stress fractures is rest. Your doctor may recommend pain relief medications and suggest a rest period combined with activity modification lasting between 4 to 12 weeks. Crutches might be necessary to avoid putting weight on the foot. Depending on the injury's location, a rigid-soled shoe or a removable fracture brace may be prescribed, and some fractures may require casting.

Once healing is underway, physical therapy can play a vital role in rehabilitation, helping to strengthen and balance the affected muscles. Aquatic therapy is especially beneficial as it reduces stress on the legs and feet while allowing for effective conditioning.

Surgery is reserved for specific fractures that do not heal with conservative treatment or for those located in areas known for slow healing. During the procedure, internal hardware, such as screws or fixation devices, may be placed to stabilize the bones while they heal. Bone grafting could also be utilized in certain cases.

Recovery duration varies based on the severity of the fracture and the chosen treatment. Surgical interventions may take several months for full recovery, whereas non-surgical treatments typically require a shorter time. Each recovery process is unique, and your doctor will guide you on what to expect as your condition improves, gradually increasing your activity level.