Abstract
Stress fractures were first described over 250 years ago and are believed to be the result of repetitive, prolonged muscular action on bone that has yet to accommodate or remodel. There is a close association with several well-known groups: military recruits, runners, and ballet dancers. Despite the easily identifiable populations, stress fractures are difficult to diagnose due to late appearance on standard radiograph. Therefore, a thorough history, a detailed physical exam, and a high level of suspicion are required to diagnose in a timely manner. Foot and ankle stress fractures make up a large percentage of the overall incidence of stress fractures with the tibia, fibula, metatarsals (MT), and calcaneus being more common and the navicular and sesamoid bones being less common. Although each bone has a slightly different etiology, presentation, and radiographic tendency, stress fractures of the foot and ankle are generally treated with activity modification and protected weight bearing, a difficult concept for the highly-active patient that usually presents. Prevention of stress fractures focuses on optimizing bone quality, sound training technique, and quality training equipment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Breithaupt J. Zur pathologie des menschlichen fusses. Medizin Zeitung. 1855;24:169–77.
Daffner RH, Martinez S, Gehweiler JA, Harrelson JM. Stress fractures of the proximal tibia in runners. Radiology. 1982;142(1):63–5.
Beck BR. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med. 1998;26(4):265–79.
Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992;159(2):245–52.
Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987;15(1):46–58.
Brockwell J, Yeung Y, Griffith JF. Stress fractures of the foot and ankle. Sports Med Arthrosc. 2009;17(3):149–59.
Hoppenfeld S, Hutton RJA. Physical examination of the spine and extremities. New York: Appleton-Century-Crofts; 1976.
Gardner LI, Dziados JE, Jones BH, Brundage JF, Harris JM, Sullivan R, Gill P. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Am J Public Health. 1988;78(12):1563–7.
McBryde AM. Stress fractures in runners. Clin Sports Med. 1985;4(4):737–52.
Levy JM. Stress fractures of the first metatarsal. AJR Am J Roentgenol. 1978;130(4):679–81.
Spitz DJ, Newberg AH. Imaging of stress fractures in the athlete. Radiol Clin North Am. 2002;40(2):313–31.
Lee JK, Yao L. Stress fractures: MR imaging. Radiology. 1988;169(1):217–20.
LEABHART JW. Stress fractures of the calcaneus. J Bone Joint Surg Am. 1959;41-A:1285–90.
Kaeding CC, Miller T. The comprehensive description of stress fractures: a new classification system. J Bone Joint Surg Am. 2013;95(13):1214–20.
Harder AT, An YH. The mechanisms of the inhibitory effects of nonsteroidal anti-inflammatory drugs on bone healing: a concise review. J Clin Pharmacol. 2003;43(8):807–15.
Wentz L, Liu PY, Ilich JZ, Haymes EM. Dietary and training predictors of stress fractures in female runners. Int J Sport Nutr Exerc Metab. 2012;22(5):374–82.
Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK. Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners. PM R. 2010;2(8):740–50.
Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature. PM R. 2010;2(10):945–9.
Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741–9.
Altarac M, Gardner JW, Popovich RM, Potter R, Knapik JJ, Jones BH. Cigarette smoking and exercise-related injuries among young men and women. Am J Prev Med. 2000;18(3 Suppl):96–102.
Jones BH, Cowan DN, Tomlinson JP, Robinson JR, Polly DW, Frykman PN. Epidemiology of injuries associated with physical training among young men in the army. Med Sci Sports Exerc. 1993;25(2):197–203.
Reynolds KL, Heckel HA, Witt CE, Martin JW, Pollard JA, Knapik JJ, Jones BH. Cigarette smoking, physical fitness, and injuries in infantry soldiers. Am J Prev Med. 1993;10(3):145–50.
Greaney RB, Gerber FH, Laughlin RL, Kmet JP, Metz CD, Kilcheski TS, et al. Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology. 1983;146(2):339–46.
D’Ambrosia RD, Drez D. Prevention and treatment of running injuries. Thorofare: C.B. Slack; 1982.
Anderson RB, McBryde AM. Autogenous bone grafting of hallux sesamoid nonunions. Foot Ankle Int. 1997;18(5):293–6.
Griffin NL, Richmond BG. Cross-sectional geometry of the human forefoot. Bone. 2005;37(2):253–60.
Milgrom C, Finestone A, Sharkey N, Hamel A, Mandes V, Burr D, et al. Metatarsal strains are sufficient to cause fatigue fracture during cyclic overloading. Foot Ankle Int. 2002;23(3):230–5.
Donahue SW, Sharkey NA. Strains in the metatarsals during the stance phase of gait: implications for stress fractures. J Bone Joint Surg Am. 1999;81(9):1236–44.
Drez D, Young JC, Johnston RD, Parker WD. Metatarsal stress fractures. Am J Sports Med. 1980;8(2):123–5.
HARRIS RI, BEATH T. The short first metatarsal; its incidence and clinical significance. J Bone Joint Surg Am. 1949;31A(3):553–65.
Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA. Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med. 2007;41(8):510–4.
Lucas MJ, Baxter DE. Stress fracture of the first metatarsal. Foot Ankle Int. 1997;18(6):373–4.
Meurman KO. Less common stress fractures in the foot. Br J Radiol. 1981;54(637):1–7.
Porter DA, Foulk DM, Rund AM. Intramedullary screw fixation for chronic proximal fourth metatarsal stress fractures: a new technique for the fourth metatarsal jones. Tech Foot Ankle Surg. 2010;9(3):147–53.
O’Malley MJ, Hamilton WG, Munyak J, DeFranco MJ. Stress fractures at the base of the second metatarsal in ballet dancers. Foot Ankle Int. 1996;17(2):89–94.
Towne LC, Blazina ME, Cozen LN. Fatigue fracture of the tarsal navicular. J Bone Joint Surg Am. 1970;52(2):376–8.
Bennell KL, Malcolm SA, Thomas SA, Wark JD, Brukner PD. The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study. Am J Sports Med. 1996;24(2):211–7.
Khan KM, Fuller PJ, Brukner PD, Kearney C, Burry HC. Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med. 1992;20(6):657–66.
Fitch KD, Blackwell JB, Gilmour WN. Operation for non-union of stress fracture of the tarsal navicular. J Bone Joint Surg Br. 1989;71(1):105–10.
Torg JS, Pavlov H, Cooley LH, Bryant MH, Arnoczky SP, Bergfeld J, Hunter LY. Stress fractures of the tarsal navicular. A retrospective review of twenty-one cases. J Bone Joint Surg Am. 1982;64(5):700–12.
Pavlov H, Torg JS, Freiberger RH. Tarsal navicular stress fractures: radiographic evaluation. Radiology. 1983;148(3):641–5.
Khan KM, Brukner PD, Kearney C, Fuller PJ, Bradshaw CJ, Kiss ZS. Tarsal navicular stress fracture in athletes. Sports Med. 1994;17(1):65–76.
Saxena A, Fullem B. Comment on torg et al, “management of tarsal navicular stress fractures: conservative versus surgical treatment”. Am J Sports Med. 2010;38(10):NP3.
McCormick F, Nwachukwu BU, Provencher MT. Stress fractures in runners. Clin Sports Med. 2012;31(2):291–306.
Kiss ZS, Khan KM, Fuller PJ. Stress fractures of the tarsal navicular bone: CT findings in 55 cases. AJR Am J Roentgenol. 1993;160(1):111–5.
Gould JS. Operative foot surgery. Philadelphia: W.B. Saunders Co; 1994.
McBryde AM, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med. 1988;7(1):51–60.
Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis. Foot Ankle Int. 1994;15(9):462–70.
Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res. 1996;325:209–17.
BURROWS HJ. Fatigue fractures of the fibula. J Bone Joint Surg Br. 1948;30B(2):266–79.
Richmond DA, Shafar J. A case of bilateral fatigue fracture of the fibula. Br Med J. 1955;1(4908):264.
DEVAS MB. Stress fractures of the tibia in athletes or shin soreness. J Bone Joint Surg Br. 1958;40-B(2):227–39.
Miller MD, Marks PH, Fu FH. Bilateral stress fractures of the distal fibula in a 35-year-old woman. Foot Ankle Int. 1994;15(8):450–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Melton, W., Jackson, J.B. (2016). Stress Fractures of the Foot and Ankle. In: Valderrabano, V., Easley, M. (eds) Foot and Ankle Sports Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15735-1_17
Download citation
DOI: https://doi.org/10.1007/978-3-319-15735-1_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15734-4
Online ISBN: 978-3-319-15735-1
eBook Packages: MedicineMedicine (R0)