How Does a Podiatrist Diagnose Stress Fractures?

One of the most common problems that doctors of podiatry encounter are stress fractures of the foot. A stress fracture is a crack in the bone. Repetitive physical activities can put pressure on the bone and cause it to crack. Stress fractures also arise from an increase in activity that happens too quickly to allow the body time to adjust.

In the foot, stress fractures most often occur in the heel and the bones of the midfoot. A doctor of podiatry may also treat a stress fracture that occurs in the ankle bones. Symptoms of a stress fracture include bruising, as well as pain and tenderness that gets worse with weight-bearing activities and better with rest.

DIAGNOSIS OF STRESS FRACTURES

The symptoms associated with a stress fracture may mimic those of other conditions that can cause foot pain.

PHYSICAL EXAMINATION

A doctor of podiatry will typically perform a physical examination when trying to confirm or rule out a stress fracture. This usually involves asking questions about the patient's activities, including any recent changes. The podiatrist will also inspect the foot visually for any abnormalities and feel it to identify any areas of tenderness.

MEDICAL IMAGING

In addition to a physical examination, a podiatrist may also perform imaging studies of the foot to identify any fracture lines. The first such study performed is usually a plain film X-ray because of its ready availability and relatively low cost. However, sometimes the fracture line is so subtle that it cannot be identified on plain X-rays.

If X-rays are inconclusive, a podiatrist may order an MRI of the foot instead. This is a more expensive imaging study, but one that produces very clear pictures. Another option is a bone scan, which involves an injection of a mildly radioactive substance, called a tracer, that shows up on X-rays. If a crack in the bone is under repair, the tracer will settle in this area, and the bone scan will identify the uptake.

TREATMENT OF STRESS FRACTURES

A stress fracture can usually be treated conservatively, i.e., without surgery.

REST

The doctor will probably recommend rest and avoidance of any activities that likely caused the fracture. Sometimes the doctor will recommend the patient not bear any weight on the injured foot for a month or two. This typically requires the patient to ambulate with crutches.

PROTECTIVE FOOTWEAR

Another option is for the patient to ambulate only when wearing protective footwear to support the bones as they are healing. An example might be an orthopedic boot, or the podiatrist may recommend a wooden-soled sandal or another stiff-soled shoe.

SURGERY

If conservative measures such as these are not effective, surgery may be required. A podiatrist may place screws or pins into the bone to hold it together so that healing can take place.

CONCLUSION

Most stress fractures in the foot heal with conservative measures in about six to eight weeks. The podiatrist may recommend an over-the-counter pain reliever, such as acetaminophen, as part of the treatment. However, non-steroidal anti-inflammatories may impede bone healing and should be avoided.

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