Increasing numbers of stress fractures

During the last few months I have seen an increasingly high number of foot stress fractures in my clinics. My assumption is that due to lockdowns and other limitations a good number of people suddenly decided to become active (mainly in the form of jogging) or increase their previous level of activity. This is per se a good thing but doing it too abruptly or without the necessary preparation can be damaging and lead to stress fractures.

Stress fractures are a very different type of fracture than those sustained after a high impact when the bone breaks and separates. They occur during low energy activities that repeatedly cause stress in the bone. This are due to microtrauma more than a high-energy trauma. 

The foot and ankle are the most common areas of stress fractures in the body. Many foot bones are susceptible to stress fractures but the most frequently affected are the metatarsals. 

A stress fracture in the metatarsal is also called a “march fracture” as they were initially described in soldiers who were accustomed to long marches, but in my practice the vast majority are seen in athletes, particularly runners. They would present with pain and swelling on the top of the foot, walking may be difficult but generally possible. 

Once the necessary tests have been done to confirm the diagnosis, metatarsal stress fractures will be treated with a period of rest from sporting activities, offloading in a boot or orthopaedic shoe and physiotherapy.