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What is a Stress Fracture of the Foot?

A stress fracture is an overuse injury to the bone caused by excessive, repetitive stresses. This is caused by an abrupt increase in the duration, intensity, or frequency of physical activity without adequate rest. The second metatarsal (long bone of the second toe) is the most common site for a stress fracture in the foot. It starts as a stress reaction within the bone, then develops into a stress fracture. A stress fracture can progress into a complete fracture in severe cases which is why early diagnosis is crucial.

Who is at Risk?

  • Athletes engaging in high-impact, repetitive activities (runners)
  • Females have been shown to be more at risk than males

Signs and Symptoms

  • Pain directly over the bone in the foot (i.e. the second metatarsal)
  • Pain without any distinct injury that gradually gets worse over time
  • Pain that started mild and over time becomes sharp
  • Pain with walking

Treatment

Treatment for stress fractures requires rest from all physical activity. Crutches and even a walking boot may be used to reduce the forces across the foot, especially for daily activities such as walking. Further imaging may be used to evaluate the extent of the stress fracture such as X-rays, MRI, or bone scan. Depending on the severity of the stress fracture, prolonged recovery can occur, but a full recovery and return to sport is achievable with proper management. A slow gradual return to sport or activity is recommended once completely symptom free. If rest and conservative treatment does not seem to be improving symptoms, aggressive measures such as surgical intervention may be deemed necessary.

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