Why is this patient experiencing foot pain?
Noted here is a periosteal reaction consistent with a stress fracture involving the third metatarsal.
The most common cause of stress fractures is a sudden increase in physical activity. This increase can be in the frequency of activity—such as exercising more days per week. It can also be in the duration or intensity of activity—such as running longer distances.
Even for the non-athlete, a sudden increase in activity can cause a stress fracture. For example, if you walk infrequently on a day-to-day basis but end up walking excessively (or on uneven surfaces) while on a vacation, you might experience a stress fracture. A new style of shoes can lessen your foot’s ability to absorb repetitive forces and result in a stress fracture.
Several other factors — from your training regimen to your diet — can increase your risk for a stress fracture.
Conditions that decrease bone strength and density, such as osteoporosis, and certain long-term medications can make you more likely to experience a stress fracture-even when you are performing normal everyday activities. For example, stress fractures are more common in the winter months, when Vitamin D is lower in the body.
Studies show that female athletes are more prone to stress fractures than male athletes. This may be due, in part, to decreased bone density from a condition that doctors call the “female athlete triad.” When a girl or young woman goes to extremes in dieting or exercise, three interrelated illnesses may develop: eating disorders, menstrual dysfunction, and premature osteoporosis. As a female athlete’s bone mass decreases, her chances for getting a stress fracture increase.
Doing too much too soon is a common cause of stress fracture. This is often the case with individuals who are just beginning an exercise program-but it occurs in experienced athletes, as well. For example, runners who train less over the winter months may be anxious to pick up right where they left off at the end of the previous season. Instead of starting off slowly, they resume running at their previous mileage. This situation in which athletes not only increase activity levels, but push through any discomfort and do not give their bodies the opportunity to recover, can lead to stress fractures.
Anything that alters the mechanics of how your foot absorbs impact as it strikes the ground may increase your risk for a stress fracture. For example, if you have a blister, bunion, or tendonitis, it can affect how you put weight on your foot when you walk or run, and may require an area of bone to handle more weight and pressure than usual.
Change in Surface
A change in training or playing surface, such as a tennis player going from a grass court to a hard court, or a runner moving from a treadmill to an outdoor track, can increase the risk for stress fracture.
Wearing worn or flimsy shoes that have lost their shock-absorbing ability may contribute to stress fractures.
The most common symptom of a stress fracture in the foot or ankle is pain. The pain usually develops gradually and worsens during weight-bearing activity. Other symptoms may include:
- Pain that diminishes during rest
- Pain that occurs and intensifies during normal, daily activities
- Swelling on the top of the foot or on the outside of the ankle
- Tenderness to touch at the site of the fracture
- Possible bruising
Plain film radiography can still be a helpful tool in evaluating for suspected soft tissue injuries (such as ACL tears) if you know what you’re looking for. Of course MRI is a much better modality, but x-ray can help guide you with your clinical evaluation.