Runners Pain Dictionary – Part 7

STRESS FRACTURES – A stress fracture is a tiny crack in the bone which is generally observed in load bearing parts of the body (such as the foot and ankle) and is often a result of overuse or of sudden or rapid changes in parameters such as intensity, duration and surface of activity. Bone weakening conditions like osteoporosis, deficiency of nutrients like Vitamin D and Calcium, repeated stress to compromised bones and inadequate healing time between stress episodes can all lead to stress fractures.

The foot and lower leg are common sites because of the load bearing they are subject to in daily activities like walking, running and jumping. It’s prevalence in the running community and in certain sports like basketball and soccer is thus, no surprise.

The most commonly observed stress fractures occur in the second and third metatarsal. The second metatarsal absorbs the maximum impact in the foot as you push off to walk and run. Some other common sites are the Calcaneous (heel), Tibia, Fibula (bones of the leg that lie between the knee and ankle), Talus (in the ankle) and the Navicular (bone in the mid foot). As a side note this might be an appropriate time to mention that the human foot has 26 bones (one fourth of all the bones in the body are in the foot), 33 joints and more than 100 muscles, tendons and ligaments!

Stress fractures can occur in athletes and non athletes alike whenever there is a sudden upward shift in intensity, such as from inactivity to more than moderate activity and increase in frequency and/or duration. The repetitive stress does not allow the weight bearing bones and surrounding muscles to adequately rest and recover between exercises. For example, rapidly increasing duration or distance of runs and wanting to pick up at last active mileage after a lay off or lean period, often results in this condition among runners. Running through pain and discomfort, inadequate recovery, improper technique (including poor technique resulting from blisters, bunions, tendonitis which can alter how the foot strikes and rolls on the ground), rapid changes in running surface (from treadmill suddenly on to the road), improper shoes, inadequate strength conditioning and inadequate bone density are some of the other plausible causes.

Some studies show that female athletes are more prone to stress fractures than their male counterparts. This may be due to decreased bone density resulting from different conditions including what is called “female athlete triad”. It’s a syndrome where eating disorders (low energy availability), menstrual dysfunction and premature osteoporosis may be present. When a girl or woman goes to extremes in dieting and exercise this condition may manifest. As a female athletes bone mass decreases her tendency to develop stress fractures increases.

Stress fractures may not necessarily show up in the initial X-rays. Symptoms may include pain that develops and worsens with movement, swelling at site, tenderness to touch, bruising etc. Treatment (apart from R.I.C.E) depends upon site and intensity of the stress fracture and most of these are usually treated non- surgically. Your doctor might recommend a scan or MRI to determine how to proceed. But rest, rehab and gradual return to activity are essential to prevent chronic conditions and longer down times. Eating a healthy diet, cross training, starting slow with activity, gradually building intensity, attention to proper footwear and listening to and respecting pain signals could help one pursue activity in a safer manner and help prevent occurrence of stress fractures.