Stress fractures of the foot and ankle

Stress fractures occur as an overuse injury. They represent a spectrum of pathology from socalled stress reactions through to complete fracture. With early detection and appropriate adjustment to the level of activity complete fractures can be avoided. The vast majority of stress fractures of the foot and anlde can be treated by activity restriction and no ill effects will follow. However certain bones have a predisposition to poor outcome and deserve special attention. This is in particular the navicular and the base of the fifth metatarsal. The diagnosis of stress reaction can be made by history of pain, initially after exercise, then during exercises and then finally constant pain in the region. This is associated with clinical swelling and local tenderness. The clinical scenario is enough to make a diagnosis of a stress reaction. Plain x-rays are of limited use in early detection of stress fractures. A radionuclear scan is the most sensitive test and will be positive within a few days. Certain bones, namely the navicular, are best imaged by CT scanning.