- The back of your heel
- Where your 2nd and 4th toes join the foot
- The inside Ball of your foot
- On the front of your shin
- On the inside of your ankle
Imaging for a stress fracture
X-rays are commonly taken as a first point of contact to rule in a stress fracture; however they have a poor sensitivity. It should be noted that a new stress fracture may not be visible on this imaging within the first two weeks after the onset of symptoms.
Bone scans can provide evidence of stress fractures in as little as a few days from onset of symptoms. The sensitivity is a lot higher than an X-ray but less sensitive than MRI. The result however can be difficult to distinguish if the cause of pain another bone complaint.
MRI is considered the gold standard imaging modality for diagnosis of a stress fracture. An MRI can also help to differentiate the cause of pain between a ligamentous and cartilaginous injury from bone.
Management of a stress fracture
Firstly treatment should be aimed at offloading the joint to allow healing to occur. This may result in limiting or discontinuing of a sport of activity. In some cases the use of crutches or a walking boot should be advised.
Depending on the severity and placement of the fracture itself surgery is on occasion required to ensure complete healing of the site. In these cases it is sometimes an area of bone with a poor blood supply that requires surgery due to the otherwise long drawn out recovery of the site. Surgery is also an option for athletes with the goal of a short return to activity.
Fractures at areas deemed low risk, can be managed conservatively. Reduced weight bearing, icing and compression can all be used to help with recovery. Manual therapy should be used to treat hypertonic muscles reducing the stress and pressure on the affected joints.
Rehabilitation plays a huge part in a patient’s recovery. Ankle, knee and hip range of motion should be checked to ensure patient has no restrictions. It is important to correct faulty biomechanics so that muscles and joints are not being unnecessarily overloaded. Following recovery strengthening programs should be followed to prevent any relapse. This phase of treatment should aid and go alongside a progressive return to activity plan.
Thanks for Reading
Lushington Chiropractic Clinic in Eastbourne is based in Eastbourne Town Centre, very close to the railway station and the bus stops. We are an award-winning clinic providing care to over 8,000 local people.
Gaillard, F., 2018. Stress fractures | Radiology Reference Article | Radiopaedia.org [online]. Radiopaedia.org. Available from: https://radiopaedia.org/articles/stress-fractures
Mandell, J., Khurana, B. and Smith, S., 2017. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiology, 46 (9), 1165-1186.
Mayo., 2018. Stress fractures – Symptoms and causes [online]. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/stress-fractures/symptoms-causes/syc-20354057
Tenforde, A., Carlson, J., Chang, A., Sainani, K., Shultz, R., Kim, J., Cutti, P., Golden, N. and Fredericson, M., 2016. Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. The American Journal of Sports Medicine, 45 (2), 302-310.
By James Revell
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