Stress Fractures Can Be a Serious Setback for an Athlete

There’s nothing more frustrating for an athlete than a stress fracture in the foot or ankle. He or she needs to train, to work harder, to raise his level of play . . . but the harder he works, the more likely he is to need time off.

Stress fractures are different from acute injuries. An acute injury is damage caused by a specific action, such as twisting the foot on the basketball court. A stress fracture is cumulative, a hairline crack in the bone caused by repetitive impact. Athletes who perform the same motion over and over again—such as tennis players, runners, gymnasts, dancers, or soccer and basketball players—are prone to stress fractures.

Increasing workouts too abruptly or changing the practice surface (say, from a clay tennis court to hard court) or changing footwear can also bring on a stress fracture.

Some bones are more critical than others. For instance, a Jones fracture in the fifth metatarsal bone (the long bone on the outside of the foot that connects to the little toe) may indicate that the athlete is a candidate for early surgery.

Follow The 10-Percent Rule

One way to protect against stress fractures is to avoid over-training. Tired muscles are less able to absorb the shock of repeated impact and stress is transferred to the bones. Sports physicians recommend that workout times be increased by only 10 percent each week.

Sudden increases in intensity, technique or frequency also can lead to injury. Another risk factor is shoes that are too worn or are too stiff to properly cushion the foot. Blisters may alter the athlete’s gait or technique, as he instinctively tries to protect the sore spot.

We see more female athletes than males with stress fractures, because women are more prone to eating disorders, irregular menstrual cycles and osteoporosis. This is called the female athletic triad, and it’s fairly common in athletes who try to keep their weight down while over-training.

How can you tell if you have a stress fracture? The only sure way is to have an imaging test such as an MRI or bone scan. Symptoms include pain that develops gradually over time and gets worse while you are training. Eventually, the pain will occur during normal daily activities. You may notice swelling or tenderness in a certain spot.

The earlier the diagnosis, the better the outcome. You’ll probably need to take a break from your training regimen and switch to a non-weight bearing exercise such as swimming. If surgery is necessary, we may insert a pin or screw to hold the bones in place during the healing period. If the fracture is slow to heal, we may consult a specialist to see if there is an underlying reason such as osteoporosis.

How To Prevent Stress Fractures

There are ways to lower your risk of stress fracture, including:

•    Make sure you have good footwear or gear
•    Begin your training regimen gradually and follow the 10-percent rule
•    Don’t make abrupt changes in your training technique or environment
•    Walk and stretch to warm up before engaging in full-blown workouts
•    Cool down after each training session

Most stress fractures occur in sports that involve running, which is why some sports medicine specialists recommend running only on clay or grass. Concrete is about five times more dense than asphalt, and can place significantly more stress on the feet and legs.

Don’t neglect nutrition. Many athletes diet to control their weight, and a deficit of calories, vitamins and minerals can contribute to poor bone density and hormonal imbalances.

A stress fracture can take months to heal, so patience is required. To make sure there is no repeat performance, the athlete should consult a good trainer or coach, and check with our staff before he or she returns to action.