Stress Fractures

Video Transcriptions

So I’m here to talk about stress fractures of the foot and ankle today. Stress fractures are actually pretty common in athletes who either increase their frequency or increase their intensity of exercise. There’s another subset of fractures or stress fractures that can happen in the foot and ankle, and that is with the elderly population, or a population of people who have osteoporosis. This is where the bone is already weakened and so the stress that’s placed on the bone is too much for the bone so it fractures. It’s fragile. Hence why they’re sometimes called fragility type fractures.

But if we get back to the stress fracture in the everyday population that has either increased their activity or their intensity, maybe they’re running longer distances, or maybe they’ve changed their terrain in terms of what type of shoe wear or terrain they’re running on. Stress fractures are basically exactly what they sound like. The stress of the bone has just been so much that it fails. We don’t think of bone as having some tension and stretch capability, but it does and the tension on the bone becomes too much to the point where the bone has to fracture.

Now, some of the areas of the foot and ankle that are affected by this are the distal tibia, or down by the ankle joint and the shin bone. The shin bone on the very front of it, kind of in the middle part of the leg, very common area to have stress fractures. Especially in runners or military recruits, and can often be misdiagnosed or thought of as just being shin splints. Now with respect to the foot, one of the common areas to have stress fractures is in the metatarsals. Those are the long skinny bones that connect the midfoot to the toes. And another bone is the navicular bone.

Most of these can be treated with non-surgical management, but some of them, depending on their location, need surgery. That is because stress fractures sometimes cannot heal. It’s already happening because the bone metabolism and its healing capability is hindered, or potentially there’s no vitamin D or calcium around to allow the healing, or potentially, again, there’s just too much stress on that area. And so some of these need to be fixed.

Generally speaking, metatarsal stress fractures, the ones that are more distal or in the shaft, can heal without an issue, meaning without surgery. They can be placed into a boot and have some protected weightbearing, and generally you can see the healing occur on the X-ray. Ones that are more proximal, especially the second metatarsal base, or perhaps the fifth metatarsal base, these areas have lower blood supply, and so these stress fractures actually tend to be more inclined to surgery, depending on the patient. It also goes with the navicular bone in the foot. That bone tends to have a lower blood supply where it stress fractures, and so it also may require a surgical procedure.

If you are planning a non-surgical management for your stress fracture, you usually need some protected weightbearing. Often the physician may think about your vitamin D and calcium, and just your general bone health to see if that can help stimulate some healing. Often, bone stimulators can be used as well. In terms of surgical management, this usually requires a period of being off the foot, but also potentially in addition to the bone stimulation and just the metabolic function and correction, it requires plates or screws, as well as also potentially some bone graft.

These go on to heal, after a period of non-weightbearing and then progressive physical therapy and weightbearing, but what’s most important is that the athlete or the patient know their limit, and they know how to gradually increase their activity. They monitor their shoe wear. They monitor the terrain. They also understand their limits and make sure that there’s a gradual progression of their exercise, as opposed to being sort of the weekend warrior type, where you go out and run five miles and you haven’t done that since college.

Stress Fractures

Video Transcriptions

So I’m here to talk about stress fractures of the foot and ankle today. Stress fractures are actually pretty common in athletes who either increase their frequency or increase their intensity of exercise. There’s another subset of fractures or stress fractures that can happen in the foot and ankle, and that is with the elderly population, or a population of people who have osteoporosis. This is where the bone is already weakened and so the stress that’s placed on the bone is too much for the bone so it fractures. It’s fragile. Hence why they’re sometimes called fragility type fractures.

But if we get back to the stress fracture in the everyday population that has either increased their activity or their intensity, maybe they’re running longer distances, or maybe they’ve changed their terrain in terms of what type of shoe wear or terrain they’re running on. Stress fractures are basically exactly what they sound like. The stress of the bone has just been so much that it fails. We don’t think of bone as having some tension and stretch capability, but it does and the tension on the bone becomes too much to the point where the bone has to fracture.

Now, some of the areas of the foot and ankle that are affected by this are the distal tibia, or down by the ankle joint and the shin bone. The shin bone on the very front of it, kind of in the middle part of the leg, very common area to have stress fractures. Especially in runners or military recruits, and can often be misdiagnosed or thought of as just being shin splints. Now with respect to the foot, one of the common areas to have stress fractures is in the metatarsals. Those are the long skinny bones that connect the midfoot to the toes. And another bone is the navicular bone.

Most of these can be treated with non-surgical management, but some of them, depending on their location, need surgery. That is because stress fractures sometimes cannot heal. It’s already happening because the bone metabolism and its healing capability is hindered, or potentially there’s no vitamin D or calcium around to allow the healing, or potentially, again, there’s just too much stress on that area. And so some of these need to be fixed.

Generally speaking, metatarsal stress fractures, the ones that are more distal or in the shaft, can heal without an issue, meaning without surgery. They can be placed into a boot and have some protected weightbearing, and generally you can see the healing occur on the X-ray. Ones that are more proximal, especially the second metatarsal base, or perhaps the fifth metatarsal base, these areas have lower blood supply, and so these stress fractures actually tend to be more inclined to surgery, depending on the patient. It also goes with the navicular bone in the foot. That bone tends to have a lower blood supply where it stress fractures, and so it also may require a surgical procedure.

If you are planning a non-surgical management for your stress fracture, you usually need some protected weightbearing. Often the physician may think about your vitamin D and calcium, and just your general bone health to see if that can help stimulate some healing. Often, bone stimulators can be used as well. In terms of surgical management, this usually requires a period of being off the foot, but also potentially in addition to the bone stimulation and just the metabolic function and correction, it requires plates or screws, as well as also potentially some bone graft.

These go on to heal, after a period of non-weightbearing and then progressive physical therapy and weightbearing, but what’s most important is that the athlete or the patient know their limit, and they know how to gradually increase their activity. They monitor their shoe wear. They monitor the terrain. They also understand their limits and make sure that there’s a gradual progression of their exercise, as opposed to being sort of the weekend warrior type, where you go out and run five miles and you haven’t done that since college.