18 year old female track star is 5 days away from a State qualification meet. She has gradually noticed increasing pain in her right foot in the mid-foot region for the past month. She runs the 100m, 400m, 1500m, and during practice also runs several kilometers per day for conditioning.
On exam she has moderate tenderness on the plantar side of her mid-foot.
In the outpatient clinic setting, you decide to obtain an X-ray of her foot.
Here is her X-ray, which was read as normal by your friendly radiologist.
No - note the small defect on the medial aspect of the mid-shaft of the 4th metatarsal. This is an early stress reaction of the cortex, indicated that the bone is inflamed and heading toward a full stress fracture if the patient does not rest the foot.
The X-ray reveals a bony stress reaction - not yet a true fracture but in the process of becoming fractured if repeated trauma continues.
Here is the follow-up X-ray in 1 month, revealing the extensive bony healing reaction (callous) to the stress reaction/fracture.
You could perform a bone scan but it is not necessary, the likelihood of it being positive is very high. If the X-ray was normal, a bone scan would help localized the stress reaction in the bone.
She should not continue running, as the risk of fracture and prolonged disability could further impact her running career in the future.
To prevent stress fractures, a cycled program of 3 weeks of intensive workouts, followed by a week of very light exercise can prevent the onset of inflammatory changes in bone due to overuse.
Patient was placed in a walking boot for 4 weeks until pain free and a follow-up XR revealed a healed stress fracture. Light weight bearing exercise limited to 30 minutes a day was then allowed for the next 4 weeks, avoiding running. Then she will resume full workouts, but cycle 3 weeks on full regimen, 1 week of limited workouts for 2-3 months. If no pain recurs, then full training can resume.
To prevent stress fractures, a cycled program of 3 weeks of intensive workouts, followed by a week of very light exercise can prevent the onset of inflammatory changes in bone due to overuse.
Back to the SFM website