Fatigue fracture in the foot
Synonyms in a broader sense
Fatigue fracture, stress fracture, marching fracture, insufficiency fracture
Definition / introduction
A Fatigue fracture at the foot is a creeping one Broken bone (fracture), which through Overloadcaused by frequent, one-sided or continuously repetitive stress (cyclic stress). It develops over a longer period of time. However, the force that acts on the foot during the overload is not sufficient here to cause the bone to suddenly break, as is the case with an acute fracture. Therefore, the exact time of the break is often not noticed.
Read more about the topic here: Fatigue fracture - you need to know that!
Causes and Risk Factors
The causes of a fatigue fracture in the foot lie in insufficient adaptation of the bone tissue to the load and consequently lead to unnatural (unphysiological) bone loss at the stressed area.
If there is constant overloading, small, as yet unnoticed breaks follow (Microfractures), which, however, if the excessive load or incorrect load persists, or due to inadequate compensation mechanisms in the bone, spread further and ultimately lead to a fatigue fracture. If the bone is healthy, it is called a stress fracture.
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Since the foot is a heavily stressed part of the body, it is particularly at risk for a stress fracture. Often lead Unusually heavy walking or running loads , such as. at the Running / jogging or in soldiers to a fatigue fracture.
In most cases this is the Metatarsus (Metatarsal bone) affected. A fracture of one or more of the five metatarsal bones (usually 2nd, 3rd, or 4th metatarsal) is called a March fracture designated. A Jones fracture, on the other hand, is the fatigue fracture of the 5th metatarsal bone.
For the disease of the fatigue fracture in the metatarsus and the heel, we have written completely separate topics: Fatigue fracture in the metatarsus and Fatigue fracture of the heel
Sudden changes in training in the form of a sharp increase in distance or speed as well as long (> 32 km), very hard or uneven running routes are possible risk factors for the development of a fatigue fracture on the foot.
Also Misaligned feet or Incorrect loads can cause a fatigue fracture of the foot in the long run. A notable misalignment of the foot is e.g. of the Arches foot (Pes excavatus), which puts increased strain on the back of the foot (instep), ball of the foot and toes while running. In this way, fatigue failure can be favored.
In addition to the excessive stress, diseases of the bone Cause breaks of this kind. There is no need for excessive stress on the bone. On the one hand, such diseases are the osteoporosis, a typical disease of old age in which the bones lose strength and are much more prone to fatigue fracture due to their porosity. Are affected mostly women with menstrual disorders or those that are in or after the Menopause are located. In these women, due to a decreased production of female sex hormones (Estrogens), the bone substance is broken down.
On the other hand, diseases like that Rheumatoid arthritis (an autoimmune disease, which too bone and Joints can attack) and the Paget's disease (a bone-degrading skeletal disease) and the rickets (one by one Vitamin D deficiency caused decrease in bone substance). In these cases one speaks of a Insufficiency fracture, that is, from a fatigue fracture of an already diseased bone.
Also Bone tumors or metastases of tumors in a foot bone can cause a stress fracture.
In addition, one increases longer use of bone-degrading drugs like that anti-inflammatory drug cortisone the likelihood of suffering a fatigue fracture.
What role does obesity play?
Normally, a fatigue fracture occurs as a result of intense exercise such as intense jogging. In the case of overweight people, however, a fatigue fracture can also arise from everyday life, for example from long walks in the city or on vacation. The heel and metatarsus are often affected. If a fatigue fracture occurs due to excessive body weight that affects the bones, long-term weight reduction should be considered.
diagnosis
Since no clear break event can be assigned to a fatigue fracture, the diagnosis is usually made late.
Diagnostic measures for the detection of a fatigue fracture are on the one hand clinical examination of the foot safe fraction symbols (Fraktur sign) how Axial misalignments of the bone, crackling of bones (Crepitation), abnormal mobility or visible pieces of bone as well as on unsafe fracture signs how Pain, swelling, bruising (Hematomas), Warming and Restrictions on movement.
On the other hand, imaging methods are like roentgen, MRI, CT or the Skeletal scintigraphy (Examination of the metabolic activity of the bones using radioactively marked substances) makes sense; where the MRI and the scintigraphy the small fault lines as well as the Loss of bone mass can best make them visible. The beginning of a fatigue fracture is often not visible in a conventional X-ray.
MRI of the foot
A fatigue fracture is often not diagnosed using magnetic resonance imaging, since the patient's symptoms and the X-ray examination also often lead to the diagnosis of a fatigue fracture with less effort. However, MRI is also the best way to detect very fine hairline cracks in the bone that would otherwise have been overlooked in a standard X-ray examination.
Over 50 percent of fatigue fractures are not yet visible in the X-ray in the early phase, but can already be diagnosed using MRI. The advantage of MRI compared to X-ray examinations or computed tomography is that the patient is not exposed to harmful radiation. In contrast to the other two procedures, an MRI scan also takes longer.
Symptoms
Since the fatigue fracture usually develops insidiously over a longer period of time, it causes other symptoms than an acute fracture.
The patients complain about Pain in the area of the broken (fractured) Foot bone initially under load, later too in peace. Often, unlike an acute fracture, the stress fracture is not associated with a sudden loss of function of the foot due to the impact of force. However, like a sudden break, it can too Overheating, swelling and redness of the foot at the break point.
Because the symptoms appear very untypical for the patient, a rheumatological disease went out.
therapy
Treatment for a fatigue fracture depends heavily on whether the diagnosis is still in Initial stage (small cracks in the bone = microfracture) or only in one later stage done with a proper fraction.
If the beginning of a fatigue fracture of a healthy bone is recognized in good time, it is usually sufficient to first stop the overstressing or improper loading that caused it and then, after a while, to resume training with less intensity. At this time of the Pause the bone has time to close regenerate and the To rebuild bone substance in the thinned areas. Supporting measures, such as light movement exercises in the form of physiotherapy treatment (physical therapy), can often accelerate regeneration. In addition, should stabilizing bandages or a plaster are used to protect the bone from excessive stress and to keep it quiet. In the so-called march fractures, relief can be provided by a special Forefoot relief shoe be achieved.
Also decongestant measures like Cooling, tape bandaging or one Lymphatic drainage can relieve pain and speed up the healing process. In the case of severe pain you can also temporarily Painkiller (Analgesics) can be taken.
A fatigue fracture as a result of an underlying disease that can affect the bones (Insufficiency fracture), should stabilized (Plaster / bandage) as well as the Underlying diseasethat could have caused the break treated become.
In the case of severe fatigue fractures or fractures that are only recognized very late, sometimes a operative therapy be necessary. Depending on the location, size and extent of the break, there are various options, such as the Intramedullary nailing, one Cancellous plastic (healthy bone tissue from the iliac crest is transplanted into the broken bone) or a Screw connection with titanium plates.
Which is the correct surgical therapy, however, must be decided individually. What all operative measures have in common is that the patient's foot for approx. Should rest for 2-4 weeks. Physiotherapy can also help speed up the healing process. After immobilization can be careful with the load and the training started and slowly increased.
prophylaxis
The best measures a fatigue fracture (Stress fracture) are to be prevented Overloads in sports to avoid getting involved individual training plans hold with not too strong an intensity and shock-absorbing running shoes to wear. In addition, long-distance runs or runs on uneven or hard ground should not be done too often or excessively.
To prevent a fatigue fracture as a result of diseases that affect the bones (Failure hernia), should possible underlying diseases, e.g. through preventive examinations in relation to the Bone densityto be recognized early. Also help, for example Vitamin preparations (Vit. D) and one Calcium substitution at the same time to prevent a decrease in bone density (bone loss = osteoporosis) in old age.
Prognosis and healing time
With good treatment and early detection of the fatigue fracture, the prognosis is very good. In most cases, a fatigue fracture of the foot heals quickly.
A fatigue fracture on the foot can also be protracted. Since we always have to put a little strain on our feet, a fatigue fracture of the foot is more protracted than other fractures. The better the foot can be protected, the faster the healing process usually takes place. The therapy usually extends over a period of six to eight weeks. During this time, the foot should be completely protected and sports should be avoided. However, it often takes up to six months before you can fully start exercising again.
What to do if the fatigue fracture in the foot does not heal?
The fact that a stress fracture does not heal is often because the foot is not protected long enough. If the pain in the foot disappears, patients often return to the full load, which is a mistake, since the foot should still be protected. Often patients do not go to the doctor for a long time, so that the foot continues to be stressed and the diagnosis is made too late.
The healing process usually requires at least six to eight weeks of rest. If the load is increased earlier, this can lead to an inflammatory process in the bone again. If conservative therapy with rest does not help, a cast or a foot splint is usually prescribed for two to six weeks so that the foot can be better relieved.
