And Lower Extremity Stress Fractures

Dr. Breithaupt was puzzled. The year was 1855, and this Prussian army doctor was noticing that many of his young military recruits were experiencing severe pain in their feet or ankles early in their basic training, particularly after prolonged marching. Dr. Breithaupt discovered that the soldiers were actually developing incomplete fractures of the bones from overuse. He called the condition “march foot , and wrote the first paper describing it. Today we call it “stress fracture”.

Stress fractures are defined as incomplete partial fractures of bones. They comprise 10% of all sports injuries, with 99% of them occurring in the lower extremity.

Unlike “pathological fractures” which occur in weakened or porotic bone (especially in elderly patients), stress fractures occur in otherwise healthy bone due to repetitive mechanical loading. It non-athletes, they often occur when a sedentary period is followed by a sudden increase in activity, or performance of an unaccustomed activity. In athletes, they occur after increasing level of training too quickly.

Risk factors for stress fractures include female gender, increased chronologic age, white race, smoking, obesity, long-term alcohol use, and sedentary lifestyle.

The signs and symptoms of stress fracture include localized pain of relatively sudden onset without a specific injury. Some swelling may be present. Pain is aggravated by activity and is relieved by rest. The most common area involved as the top of the forefoot, in the area of the metatarsal bones.

Diagnoses in the early stage of the injury may be difficult. Although clinical signs are suspicious, the stress fracture will often not appear on x-ray for the first 2 weeks. Diagnostic ultrasound or MRI are valuable in the diagnoses of an early stress fracture and in the confirmation of the diagnosis.

Treatment is fairly simple and is highly successful. Modified activity and immobilization of the affected area for a period of time is the preferred treatment. Often, a removable walking boot will be utilized for more rapid and effective healing.

If you have pain and or localized swelling in the lower extremity, it might be a stress fracture. Seek a consultation from our doctors at Melbourne Podiatry Associates.

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