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What do a military soldier, a Zumba instructor and an avid hiker have in common?

The answer is stress, but not necessarily mental stress. These and other people like them are prone to stress fractures of their feet.

A stress fracture is a hairline fracture caused by overuse. In the foot, the muscles become fatigued from being overworked. The shock absorption ability of the muscles is lost and the bones in the foot take over to try to reduce the force. This repetitive force can eventually cause the bone to “break” or fracture.

Stress fractures often go undiagnosed and even X-rays may appear normal the first two to three weeks. Symptoms of a stress fracture are pain and swelling. Pain worsens when the foot bears weight or with increased activity, and pain also becomes more severe as the day progresses. The majority of the time we can associate increased physical activity prior to the onset of the pain and swelling. The most common bones to have stress fractures in the feet are the metatarsals and the heel.

To prevent stress fractures, you should slowly work up the intensity of your activity level. Appropriate shoe gear is necessary for these activities to reduce shock. The shoes should be supportive with flexibility at the ball of the foot. Too stiff a shoe will cause excess pressure.

Women are more prone to stress fractures and need to make sure their calcium levels are good. Having a doctor check for osteoporosis is also a good idea.

These fractures are usually diagnosed by the history and symptoms. As stated above, the initial X-rays may look normal. Diagnostic ultrasound, bones scans and MRIs can be helpful in making a diagnosis when the X-rays are normal. X-rays after three weeks should show evidence of the fracture trying to heal, and this will be visible on the X-ray.

We have been seeing a lot of conditions we classify as “stress reactions.” These stress reactions do not turn into full-blown fractures and are more difficult to diagnose and treat.

Treatment of stress fractures begins with ceasing any activity that is putting excessive pressure on the fracture site. Depending on the location, you may have to be totally non-weight bearing or use a walking cast boot or be casted. Rarely is surgery indicated for stress fractures. Most of the time, we can have people continue their working activities with some modification.

If your foot is painful, has swelling and hurts as the day goes on ... don’t neglect it. Get it checked out and make sure you don’t have a stress fracture.

Remember: Better health through better motion.

Dr. Seth J. Steber is a foot and ankle surgeon with Carlisle Foot & Ankle Specialists specializing in simple and complex foot and ankle reconstructive surgery, lower extremity nerve pain and chronic wounds. He is a Fellow of the American College of Foot and Ankle Surgeons and the Association of Extremity Nerve Surgeons. For more information, visit www.MSIFootandAnkle.com.

Steber is one of five Carlisle Regional Medical Center physicians contributing to the weekly Health Talk column, to appear in The Sentinel every Sunday.

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