Foot and Ankle

Our feet and ankles are being used everyday for various daily activities. Hence, injuries to the foot and ankle are very common.

The ankle is made up of 3 bones that meet at the ankle joint: the tibia (shinbone), fibula (smaller bone of the lower leg) and talus (small bone in between the tibia and fibula and the calcaneus). The ankle joint where these 3 bones meet are encased by a joint capsule, which contains synovial fluid. This synovial fluid is important as it allows for smooth movement of the joints. The ankle is surrounded by ligaments, which help to stabilise it.

The foot is a complex structure of the body, consisting of 26 bones, 33 joints, 107 ligaments, and 19 muscles. The bones can be categorised into 3 sections:

Forefoot

The forefoot consists of your toes (phalanges) and metatarsals

Midfoot

The midfoot consists of bones that make up the arch of your foot

Hindfoot

The hindfoot consists of the heel and ankle, where the talus and the calcaneus (heel bone) are found.

Muscles, ligaments and tendons in the foot help stabilise your foot and allow for complex movement and motions. As there are many bones in the foot, fractures can occur at many locations in the foot, such as toe fractures, metatarsal fractures or calcaneus fractures. Another type of fracture that can occur in your foot is a stress fracture, which develop due to stress overtime.

Stress Fracture of the Foot

WHAT IS A STRESS FRACTURE OF THE FOOT?

A stress fracture of the foot is a tiny crack in the bone of the foot. When the bones in the foot are being overused and overstressed due to repeated activity, such as in runners who repeatedly run long distances or basketball players who repeatedly jump, this causes a stress fracture to develop over time especially if the bones and muscles do not have enough time to rest in between sessions.

Stress fractures are most commonly located in the weight-bearing bones of the foot, such as the calcaneus (heel), metatarsals, fibula, talus and navicular.

WHAT ARE THE SYMPTOMS OF A STRESS FRACTURE OF THE FOOT?

Common symptoms of a stress fracture of the foot include:

  • Pain during an activity but goes away during rest
  • Pain that occurs and intensifies during normal, daily activities
  • Pain, swelling or aching at the site of fracture.
  • Tenderness at the site of the fracture when touched
  • Bruising
  • Pain during weight-bearing on the injured foot

WHAT ARE THE CAUSES AND RISK FACTORS OF A STRESS FRACTURE OF THE FOOT?

Some causes and risk factors of a stress fracture of the foot include:

  • Overuse and repetitive motions of the foot, such as in certain sports (running, basketball, gymnastics)
  • Sudden quick change in the intensity of the activity
  • Gender (women are at higher risk especially if their menstrual cycle is irregular)
  • Bone structure of the foot (some people are born with foot conditions such as flat feet or a high arch, which increases the risk of stress fractures)
  • Bone conditions such as osteoporosis which cause your bones to be weaker, and the lack of vitamin D and calcium can also increase your risk of stress fractures
  • Previous injury from stress fractures

 

WHAT IS THE DIAGNOSIS OF A STRESS FRACTURE OF THE FOOT?

A history of the injury and a physical examination of the foot will be conducted by the Doctor.

Imaging tests will be taken, such as x-ray. However, it is hard to get a stress fracture to show up on the x-ray as it is very tiny. A bone scan will be ordered, as well as an MRI scan for the doctor to see the details of your bone structure and where the stress fractures are located. An MRI scan is also more helpful to differentiate between stress fractures and soft tissue injuries.

WHAT ARE THE TREATMENT OPTIONS FOR A STRESS FRACTURE OF THE FOOT?

The type of treatment depends on the location of the fracture and how severe is it. Most stress fractures are treated with nonsurgical treatment options. These include:

  • RICE therapy (Rest, Ice, Compression, Elevation)
  • Medications for pain-relief (acetaminophen) and anti-inflammation (ibuprofen)
  • Protective footwear to protect your feet while it heals, such as a stiff-soled shoe
  • Walking supports such as crutches
  • Wearing a cast to hold your foot in place and helps the healing process

 

Should nonsurgical treatment prove ineffective in relieving symptoms, or if your stress fracture requires surgery to heal properly, a surgical procedure called internal fixation will be carried out. This procedure involves aligning and holding the bone fragments together with pins, screws or metal plates. The bone fragments will be held in place for healing.

 

WHAT IS THE RECOVERY PROCESS AFTER SURGERY FOR A STRESS FRACTURE OF THE FOOT?

Depending on the type of stress fracture, on average it takes from 6 to 8 weeks for it to heal. Stress fractures that are more severe can take longer time to heal. Once your stress fracture has healed and pain has subsided, you may return to your regular activities.

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