Stress Fractures of the Foot and Ankle

Abstract

Stress fractures are relatively unique to the athletic population with up to 98.5% of all stress fractures occurring in the athletic population. However, stress fractures are a rare entity even in the athletic population, yet they can have a high morbidity. Stress fractures are the result of repeated submaximal loads without adequate recovery time or inadequate biologic repair. Multiple factors contribute to the etiology of these injuries including type and frequency of activity, shoe wear, playing surface, vascular supply, osseous anatomy and alignment, and endocrine abnormalities. Most stress fractures of the foot and ankle can successfully be treated nonoperatively with nonweightbearing for 4-6 weeks with provisions for early range of motion and progressive return to weightbearing in a fracture boot. Base of the fifth metatarsal, navicular and medial malleolus stress fractures have a higher risk of displacement, malunion, nonunion or delayed union and should be considered for early surgical fixation in the athlete to limit time away from play and ensure timely healing. Adjuvants to treatment including vitamin D and calcium supplementation, daily bone stimulator, and biweekly shockwave therapy should be used liberally in the athletic population if feasible. Early diagnosis and treatment can decrease the time away from activity, thus a high index of suspicion is critical in this population. Advanced diagnostic imaging should be used liberally in athletes to identify these injuries early. The following chapter will discuss the etiology, epidemiology, presentation, and management of specific stress fractures of the foot and ankle as they pertain to the athlete.