FOOT STRESS-FRACTURE (March Fracture; Fatigue Fracture) |
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General Information
DEFINITION--A complete or incomplete hairline break in a foot (metatarsal) bone. The term MARCH FRACTURE arose during World War I when many young soldiers, not conditioned for stress, were put into ill-fitting shoes and required to take long hikes over rough terrain. The X-ray appearance may be similar to a bone tumor. Stress fractures may not appear clearly for several weeks after pain begins in the foot.
BODY PARTS INVOLVED
Metatarsal bones of the foot.
Metatarsal joints.
Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Pain in the foot when walking or running. Pain diminishes or disappears when the load is taken off the feet.
Tenderness to the touch in the fracture area.
CAUSESFatigue of the foot bone(s) caused by repeated overload, as with marching, walking, running or jogging.
RISK INCREASES WITH
Adults over age 60.
Walking, running, jogging or standing for prolonged periods.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
HOW TO PREVENT
Heed early warnings of an impending stress fracture, such as foot pain after extended standing or walking. Adjust activities before a fracture occurs.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis and care.
Physical therapy and rehabilitation.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of both feet and ankles. X-rays are often normal for the first 10 to 24 days after symptoms begin.
Radioactive technetium 99 scan (See Glossary), if symptoms are typical but X-rays are negative.
POSSIBLE COMPLICATIONS
Complete fracture from continued stress on the foot after symptoms begin.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissues.
Problems arising from plaster casts, splints or other immobilizing materials. See Appendix 2 (Care of Casts).
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex and previous state of health and conditioning. The average healing time for this fracture is 6 to 8 weeks with adequate treatment. Healing is considered complete when there is no pain at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This injury develops gradually.
CONTINUING CARE
This fracture does not require setting (realignment) because the fractured bone is not displaced.
Immobilization may be necessary. If so, a rigid walking cast will be placed around the foot, ankle and lower leg for 3 weeks, followed by a supportive shoe. Sometimes a stiff-soled shoe provides enough support and immobilization to allow healing.
Use frequent ice massage after the cast is removed. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen or ibuprofen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Don't bear weight on the injured foot. Learn to walk with crutches, and use them through the first week with your walking cast. See Appendix 3 (Safe Use of Crutches). Prop your foot up whenever possible.
Begin reconditioning and rehabilitation after clearance from your doctor.
Resume normal daily activities gradually after treatment.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have unexplained foot pain.
Toes become dark, blue, cold or numb while the cast is on.
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