Stress fractures are hairline fractures that occur most often in the bones of the foot and less commonly in the lower leg. They can occur elsewhere in the body as well, but this is more rare. They're usually the result of overuse - most typically from running.
Normally, the connective tissues (ligaments, tendons, muscle) of the lower leg and foot absorb the impact of activity. However, once their capacity to absorb these stresses is exceeded, the bones become more responsible for absorbing and distributing the forces of impact. When the bones are overstressed coupled with inadequate time for recovery, the bone will develop a stress fracture.
Diagnosing Stress Fractures
Foot and lower leg pain (over the fracture site) is the first sign of a fracture. Aches and pains associated with running are very normal and common especially in newer runners. But, they should go away within a few days, after some rest. If the pain doesn't resolve in this time frame, you need to get it checked out.
X-rays usually don't show new stress fractures – they aren’t the best tool to detect them. However, if you've had the pain for weeks it may then show up on an x-ray as changes in the bone allow it to be better seen by this method. However, chances are that when you go into the doctor complaining of foot pain, you're going to get an x-ray first thing, anyway! Then, if the x-ray doesn't show anything, time to get an MRI, or a bone scan. These imaging methods are much better at finding stress fractures. So keep this in mind if you have these symptoms, but your x-ray doesn't show a fracture - it may be too early to tell! If the pain persists, make sure you follow up with an MRI to get an accurate diagnosis.
Causes of Stress Fractures
Repetitive pounding on the bones of the foot is the most common cause of stress fractures. We see three main types of people who get them:
Casual runners that constantly run on concrete. Usually this is a person who has decided to get back in shape and does all of their running (and rapidly increases the mileage without enough time to adapt) on concrete sidewalks.
Women with thinning bones - most often we see this in menopausal women who have thinner bones because of their hormonal status (low hormones lead to weakened bones). Younger women can have low hormones as well, which can be a result of diet and excessive training. See our article on Female Athletic Triad.
High mileage runners - there is no single definition of "high mileage" but as little as 30 or more miles a week could be enough to generate a stress fracture; runners who log more miles than this are at higher risk of developing stress fractures.
Other causes include poor footwear (not wearing real running shoes, old worn out running shoes, shoes that don't fit your running style, etc).
Ok, now we can stop picking on the runners. Other high-impact sports athletes, like gymnasts and volleyballers, can get them as well. Simply put, too much pounding without adequate rest is how stress fractures develop.
Symptoms of Stress Fractures
These are the most commonly encountered symptoms of stress fractures. Keep in mind much of the time fractures in the foot typically occur along the 2nd and 3rd metatarsals, the long thin bones of the foot; also this pain is typically felt along the top or side of the foot more so than the bottom.
Bone pain with activity
Resolves with rest
Worse at night
Tender to touch
Swelling over injured area
Treatment of Stress Fractures
First and foremost, you need to rest. Injuries, especially stress fractures, demand that you rest and allow the bone to heal! You'll probably need about 2 months of rest.
Supplying the bone with the right nutrients is a good way to ensure it has everything it needs for rapid healing.
When we think of bones, calcium comes to mind of course. But there’s more to bone growth than just calcium. Your body also needs other nutrients like Ipriflavone, Boron, Vitamin K2 and Vanadium to complete the bone healing process.
Osteo Formula contains all of these, as well as 600 milligrams of three different forms of well-absorbed calcium for a synergistic formula that heals bones rapidly.
Vitamin D3 is important because it helps your body to absorb the calcium in your diet. Most people are low in Vitamin D (you can get a blood test to find out you should be above 50 ng/dl for optimal bone health) and supplementing is important for immune system health in addition to keeping bones healthy.
Testosterone is an important hormone for bone development and strength. While women do make some, levels tend to decline with age. If you're a post-menopausal woman and have a stress fracture, making sure you have adequate levels of testosterone can speed healing. DHEA, or dehydroepiandrosterone, is a natural hormone available in supplemental form that can help raise a woman's testosterone levels a bit - it doesn't work so well in men - and is safe when used at recommended doses and isn't something you need to take long term.
Omega-3 Fatty Acids are a vitally important nutritional supplement for all forms of inflammation, including that which occurs in stress fractures. They have also been shown to reduce the risk of bone fractures and even protect against bone loss!
Lastly, alkalinizing your body will keep you from robbing minerals (i.e. calcium out of the bones) and slowing bone healing time. Our bodies maintain a very small window between acid and alkaline balance. Too much processed food, alcohol, sugar and other junk makes us acidic, whereas plenty of vegetables and fruits create alkalinity. It's been said that American women as a whole take more calcium supplements than any other group of women in the world yet they have more osteoporosis. Why do you suppose that is? It's because of the predominately acidic Standard American Diet (SAD). Our body works to buffer the acidity of diet by pulling minerals from the bone. Overtime, the bones are weaker because of this.
Clearly, calcium isn't the only answer to strong bones. If you're dealing with a stress fracture (or any other chronic health condition for that matter), you can alkalinize your body by consuming more plant foods, or use a supplement like Greens First or Greens First Berry. Both products contain large amounts of plant foods in a powder form that actually tastes good - we put a scoop in our smoothies every morning to boost the amount of phytonutrients in our diets.
As amazing as the body is at healing itself, and seeing how persistent some stress fractures can be, we suggest you do more than just waiting for the bone to heal all by itself and take some of the steps outlined above!
How To Prevent Stress Fractures
Make sure you have a decent pair of running shoes, and replace them often! (Every 6 months of consistent running or 200 miles tops!).
The 10% Rule: Don't increase your mileage by more than 10% each week.
Stay off pavement sidewalks. Run on asphalt or even better, trails.
Get adequate rest as your training progresses.
Keep your diet alkaline - lots of veggies and fruits!
Not taking the proper steps to heal a stress fracture can lead to more time off, re-injury, chronic foot problems and constant pain. Take the time now to rest and heal your body so that you can get back to doing what you love as soon as you can!