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Is my pain due to a stress fracture?

What is a stress fracture?

A stress fracture is a specific type of fracture that occurs when stress is rapidly increased on normal bones. If the bone is repeatedly subjected to high levels of stress without adequate rest periods, it may not have the opportunity to repair itself and may eventually experience fatigue fracture, which is also known as stress fracture. This type of fracture is distinct from the typical fractures that can result from trauma or significant injury.

What are the common sites for a stress fracture?

Common areas for stress fractures include:

  • The foot, particularly the metatarsals (the long bones between the toes and ankle) and the calcaneum (the heel bone).

  • The femur (the long thigh bone) and hip

  • The tibia (shin bone).

What are the causes of stress fractures?

The causes of stress fractures include:

  • When individuals begin a new training or activity or increase the intensity, it can put an excessive load on their bones. This includes factors such as the duration/length of the activity, its frequency, or the type of activity.

  • Stress fractures are commonly observed in active athletes, such as those training for a marathon or in military personnel. However, they can occur in anyone who undergoes a significant increase in physical activity, especially within a short period.

Stress vs insufficiency fractures

Insufficiency fractures are another different category of fractures. They happen when the bones are softer and weaker, also called osteoporosis, and therefore may undergo a fracture within minimal pressure. Several factors, such as deficiencies in nutrients and vitamins or certain medications, can cause insufficiency fractures. They are prevalent among the elderly and commonly affect the lower back, particularly the sacrum.

How to tell if I have a stress fracture?

The initial symptoms of a stress fracture can be non-specific, including pain after activities such as running or playing football. Initially, the pain is usually mild and can be misinterpreted as a tendon strain or arthritis. The pain usually improves with rest.

If there is a progression in the condition, the symptoms may become more severe, with pain interfering with daily activity and may persist even at rest or night-time. Additionally, the pain may restrict your ability to perform basic everyday activities, such as walking.

What other conditions can mimic a stress fracture?

Other conditions that can be mistaken for a stress fracture will depend on the site of the stress fracture. Overall, these include:

How to diagnose a stress fracture?

Assessment usually starts with a thorough clinical examination to assess the area of pain and look for other symptoms and risk factors for a stress fracture. Imaging is a very important component of the assessment. This usually starts with an X-ray. It is important to know that X-rays can look normal in the early stages of a stress fracture. Sometimes, these fractures are picked up on repeat X-rays. Alternatively, an MRI scan is very sensitive for early changes of a stress fracture.

What is the treatment for a stress fracture?

To treat a fracture, it is recommended to rest and reduce physical activity intensity. Supportive devices such as crutches may lessen the pressure on the affected area. Low-impact exercises like swimming and cross-training can also be beneficial in reducing pressure on the bone.

Additionally, icing and elevating the area can help alleviate pain. Painkillers like paracetamol may also be used, but it is best to avoid anti-inflammatory painkillers like Ibuprofen and Voltarol as they could potentially interfere with the healing process.

Physiotherapy and a tailored rehabilitation program can also aid in the treatment process. Your therapist will guide you in gradually reintroducing activities rather than abruptly resuming them.

Vitamin D deficiency, for example, is common in the UK; a simple blood test can help assess its level and direct the treatment. If there is concern regarding reduced bone density, a special type of X-ray (called a Dexa scan) is also performed to assess this.

Can ultrasound-guided steroid injections help in the management of a stress fracture?

Generally, steroid injections are not used in the management of stress fractures. A steroid injection can delay or interfere with fracture healing and therefore is not used to manage a healing fracture. There are a few specific indications for using a steroid injection in the management, for example, if the fracture has healed but resulted in a focal area of inflammation to the adjacent soft tissue or bone. These are only done after a review by an orthopaedic specialist.

Sometimes, we perform an ultrasound-guided injection of local anaesthetic (numbing medicine) into the area of pain to help the orthopaedic doctor pinpoint the exact problematic site. These injections are mainly done to confirm the diagnosis rather than treat the condition. Using ultrasound guidance ensures accuracy and safety when performing these injections.

Foot & Ankle conditions and treatments


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