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All about stress fractures

Recently, a patient came into my clinic complaining of foot pain. The patient reported that he first noticed the pain about two months ago and the pain had slowly worsened. During the history portion of the examination, it was revealed that the patient works for a courier service. As part of his daily job, he is required to climb in and out of his delivery truck roughly 50 times per day. After examining his foot, I decided to send him for x-rays.  As it turns out, the x-rays showed that the patient had a stress fracture in one of the bones in his foot.

Stress fractures are simply small cracks in a bone. In most cases they are caused by repetitive force or overuse. In the case of my patient, it was the repeated force of jumping in and out of his truck that caused the stress fracture to occur.

Due to the high amounts of force, the weight-bearing bones of the lower leg or foot are generally the most susceptible to stress fractures. Endurance and track-and-field athletes are most at risk, however anyone can experience a stress fracture. Also, conditions such as osteoporosis can weaken bones and make it easier for a stress fracture to occur. 

In addition, if bones are subjected to high forces that they are not accustomed to and not given enough recovery time, the bone may become fatigued. If this pattern is maintained for a long period of time, a stress fracture may form. A good example is starting a vigorous exercise routine when you have been previously living a sedentary lifestyle. Increasing the intensity and/or frequency of physical activity too quickly increases the risk of stress fractures.

In most cases, the pain associated with a stress fracture is mild at first. However, over time the pain will worsen and can become very intense. The pain is usually localized but can also radiate to other areas around the fracture site. Swelling and inflammation is usually present. It is important to seek medical attention if the pain becomes severe or persists even at rest.

In order to confirm the presence of a stress fracture, your doctor may order an x-ray. In many instances, stress factures will not show up on an x-ray for several weeks. As a result, your doctor may recommend more sophisticated diagnostic testing such as a bone scan or MRI.

Once a stress fracture has been diagnosed, treatment can begin immediately. Generally, the most important component of treatment is giving the bone enough rest to heal. This may take several months. In order to reduce the load on the bone, crutches, braces or walking boots may utilized. In rare cases, surgery is required to ensure complete healing. Anti-inflammatory and pain medications may be prescribed to help control pain and discomfort.

It is important to listen to your doctor and follow his or her instructions about resuming activity. It is vital to slowly progress from non-weight bearing or low impact activities such as swimming to your normal activities. If high-impact activities are introduced too early, it may cause a re-injury of the stress fracture.

Although it is impossible to completely prevent a stress fracture from occurring, there are a few simple things to keep in mind that can help reduce the risk. Firstly, make changes to your physical activity slowly and gradually. Next, try to vary the type and intensity of physical activity in order to reduce repetitive loads or stress on the bones. Finally, maintain a proper and balanced diet to make sure your bones get all of the nutrients they need to stay healthy and strong. Until next time, drive safely.


Dr. Christopher H. Singh runs Trans Canada Chiropractic at the 230 Truck Stop in Woodstock, Ont. He can be reached at 519-421-2024.

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