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Stress fractures -- or "March" fractures, as they are known in the military (because they frequently develop from marching) -- are common injuries that can occur in the lower extremity, especially among athletes. There is a disruption in the continuity of normal bone caused by repetitive microtrauma to an area. A stress fracture develops over a period of many days, weeks or months. By contrast, acute trauma typically results from one incident -- a fractured ankle from a severe twist, for example, or a fractured metatarsal from a heavy object falling on it.

The typical scenario is that an athlete develops localized pain and swelling. The pain worsens with activity and improves with rest. The onset of pain and swelling is usually gradual and may hardly be noticeable at first. There is generally no history of an obvious injury to the athlete. Usually the athlete will tell of participating in a new strenuous activity, increasing the intensity of an old activity or participating at a very high level for a long period. 

Treatment for stress fractures consists of relative or absolute rest. This will depend on the bone or bones involved, and the severity and stage of the fracture. The activity that caused the injury must be avoided to prevent delayed or improper healing. Athletes wishing to maintain their fitness level may participate in low-impact activities such as swimming, biking or water running – but, again, this would depend on the bone fractured and the stage of healing. Casting or bracing may be indicated for stress fractures that are at risk of complete fracture or displacement. A period of non-weight bearing with crutches may be helpful along with the use of anti-inflammatory medications. 

When the rest period is complete and the patient has remained pain-free for two weeks or so, supervised rehabilitation is initiated along with a gradual return to activity. Returning to activity too early or increasing the amount of activity too quickly may initiate the stress fracture process again. Care should be taken during the first four weeks since this is the most vulnerable time during a fracture’s reparative process.

Stress fractures can be difficult to manage, especially in the competitive athlete. Failing to recognize the possibility of a stress fracture or to follow a supervised rehabilitation plan can seriously delay athletes’ return to competition and/or predispose them to future stress fractures.

Brought to you by Doctor John A. Hardy, owner of Toronto's foot clinic, Academy Foot and Orthotics Clinic.


Toronto, ON Chiropodist Academy Foot and Orthotic


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