Stress fractures are a type of overuse injury. These fractures, which may be partian or incomplete, result from repetitive subthreshold loading that, over time, exceeds the bone's intrinsic ability to repair itself. The repetitive forces of running or jumping, and even benign activities such as walking, can cause these injuries. Stress fractures can occur in any bone, but most often afflict the weight-bearing bones of the lower leg and foot. Common stress fractures of the foot: Metatarsal 2nd and 3rd Navicular Calcaneus

Symptoms Localized bone pain Pain exacerbated with weight bearing With or without localized edema

Diagnosis

• History of localized bone pain and swelling without specific trauma.
• Plain film x-rays are usually unrevealing for 10-14 days, at which time a periosteal reaction may be visualized.
• Digital x-rays are superior to plain film due to magnification abilities which allow identification of even very fine fractures.
• Diagnostic ultrasound can detect peri-fracture edema in 24 hours.
• CT and MRI are better than plain films and can be used to evaluate the extent and direction of a stress fracture but are usually not used for initial evaluation.
• Triphasic Nuclear Bone Scans are still the gold standard for difficult cases.

Treatment
Stress fractures are notoriously underdiagnosed and under treated. This injury carries the risk of complete fracture, displacement, and avascular necrosis, and may result in chronic disability. R.I.C.E. (Rest. Ice. Compression. Elevation.)is always a good first step.

• Fracture-healing boot or cast for 4-6 weeks
• Running and jumping should be avoided for an additional two weeks
• Orthotics: Reinjury is common, especially among athletes. When returning to activities the use of orthotics and proper footwear will help prevent future occurences.

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