Stress fractures of the foot are common in athletes

By BOB MASSEY

Feeling Fit Correspondent

Athletes don't like to be sidelined. And that can be a problem when dealing with stress fractures of the foot.

Unfortunately, they are the most likely candidates for stress fractures -- small, nearly invisible cracks in the bone that are not always easy to detect. When most people think of fractures, they imagine a clear, obvious break. But these are different -- and don't require the traumatic impact usually associated with bone fractures.

"We do see stress fractures that occur in runners, or in patients that start a new activity level -- they're used to run a mile and now they start running two or three miles all of a sudden," said Dr. Arlo Yaege, a podiatrist with Foot & Ankle Centers of Charlotte County. "It occurs when there's a drastic change -- or even a change in shoes, in some of our older population."

One thing stress fractures should never be is ignored. Stress fractures of the foot have been recognized for some time. Aristotle described them as early as 200 B.C.

More recently, a Prussian military physician named Breithaupt is credited with identifying what he called "march" fractures.

The condition occurs in the bones of the foot that are used to bear body weight. They most commonly occur in the second and third metatarsals of the foot, but can also be found on top of the midfoot, heel or lower leg.

Stress fractures are traditionally associated with overuse due to tired muscles. When the muscles have difficulty absorbing the shock of impacts made on the foot, they transfer the stress to the bones, which then become vulnerable to fractures.

This is why athletes who participate in high-impact sports -- running (especially distance), basketball, gymnastics, tennis, volleyball, soccer, track and field -- are at highest risk. On the plus side, research has shown that those who participated in such sports as children have a decreased risk as they get older -- presumable because their bodies developed the proper musculature to handle impact at a young age.

Too much conditioning that overworks the muscles, weakness of core muscles, poor body mechanics or a weakened bone structure (such as through osteoporosis) can all contribute to stress fractures. And women are more likely to develop the condition than men.

Stress fractures sometimes can be difficult to diagnose because they don't always hurt. Some patients will only see bruising.

"Some people perceive pain much differently and they say, 'Oh, I didn't know that it was broken,' " Yaege said. "There are some people -- because of their activity levels or their pain threshold -- who just mark it off and move on. To them, if the foot looks the same. O r if the foot swells but the swelling goes down, they won't think twice about it. Everyone should -- if they have some kind of injury or sudden pain they're not sure of -- get it checked out."

If not, and pressure is applied, the crack could become a full break -- which can cause worse problems.

"If a patient has a stress fracture in a supportive area, it needs to be repaired. It could cause an abnormal alignment -- which could lead to arthritis if it affects the joint. Then you could be looking at more significant repairs down the road."

The best treatment for recovery of a stress fracture is rest, so that the bone can heal. But that can be easier said than done when it comes to athletes.

If the patient is involved in sports at the high school, college or professional level, the season provides a narrow window of time in which he or she can participate. For a physician, it becomes a challenge to reduce the healing time as much as possible so that the athlete can return to the activity safely.

Depending on the fracture, little intervention may be required on the part of the physician.

"If it doesn't hurt, and it's the type of fracture where it's not structurally 100-percent needed for your everyday activities, I'll brace them, cast them and let the injury heal on its own -- instead of pushing them for surgery they might not need," Yaege said.

It's possible for stress fractures to be prevented. Some suggestions include:

•Cross-training or using a variety of exercises to prevent repeated stress on the same area of your foot and ankle.

•Eating bone-strengthening foods rich in calcium and Vitamin D.

•Wearing adequate shoes, especially for sports.

•Starting any new sports activity at a gradual pace.

•Strength training to increase the capability of the load placed on the muscles.

If, in spite of your best efforts, you believe you may have developed a stress fracture, get it checked -- before it gets worse.

For more information, contact Charlotte County Foot & Ankle centers at 941-627-5161 (Port Charlotte) or 941-639-0025 (Punta Gorda), or visit www.ccfootcare.com.