Avoid Running Into Trouble

Foot pain, swelling could signal stress fracture

Now that spring has arrived, we’ll be spending more time outdoors. Many people will return to walking or running for exercise or playing outdoor sports after being cooped up at home over the winter. It’s the time of year doctors tend to see an increase in overuse injuries, which occur from repetitive stress on a muscle, bone or joint over time. People often develop this type of injury after ramping up a sport or athletic activity too quickly. 

One of the most common overuse injuries is a stress fracture, and the foot is particularly vulnerable, according to Mark Drakos, MD, an orthopedic surgeon specializing in foot and ankle injuries at Hospital for Special Surgery (HSS) in New York City and medical director of HSS Long Island in Uniondale. 

Repeated impact on a bone that is starting to weaken from overdoing it can eventually lead to a small break or crack. A stress fracture does not cause the bone to shift position.

“When people think of bones, they think they’re hard like metal, but the bones in the foot are more like tree branches,” said Drakos, who is an assistant team orthopedist for the New York Knicks. “They can bend a little bit, and if you bend them enough times, they can crack; the foot is one of the most common locations to sustain a stress fracture because we are constantly on our feet.” 

The foot is an anatomical marvel, with 26 small bones, 33 joints and a network of more than 100 muscles, tendons and ligaments that work together to support our body weight, provide stability, and allow movement. Our feet are designed to absorb a tremendous amount of force with every step we take. 

Stress fractures are often seen in runners, in athletic people who participate in high-impact repetitive sports and in older people who have weakened bones, Drakos said. Individuals who don’t rest adequately in between workouts or keep playing a sport despite exhaustion are at increased risk, as are people who take steroids. 

David Wang, MD, a primary sports medicine physician at HSS Paramus in New Jersey, saw an increase in stress fractures in people who were inactive during the pandemic lockdown and then resumed an activity too quickly.

“The challenge is that when you’ve been inactive for so long, the body gets weaker and cannot handle an activity at the previous intensity,” he Wang explained. “We still want people to be active, and the cliché I always use is ‘slow and steady wins the race.’ The key is to gradually build up your activity to make sure your body can handle the load. If you’ve never run before and want to start running, for example, start with walking first, then jogging and then gradually start running.”

The main symptom of a stress fracture is pain, which generally occurs in the spot where the bone is broken, according to Drakos. People may also experience swelling and bruising. Anyone who may have suffered a stress fracture is advised to immediately stop any activity that is causing the discomfort. The main treatment for a stress fracture is rest. 

For pain that comes on suddenly, people can try using ice and elevating their foot to see if the pain improves. If it doesn’t get better after a few hours or people start experiencing pain on days they’re not working out, the experts recommend seeing a doctor.

A stress fracture is diagnosed based on a discussion with one’s doctor about recent activities, any possible injury and where the pain is felt. The physician will examine the foot and order X-rays. Sometimes a CT scan or MRI is also prescribed to make the diagnosis.  

Surgery is rarely needed for a stress fracture, according to Drakos.

“As a general rule, many fractures of the foot can be treated without surgery by wearing protective shoe wear: either an orthopedic boot or a hard-soled shoe,” said Drakos. “People can generally put weight their foot when wearing the protective footwear.” Most stress fractures heal in four to six weeks. 

Drakos said lifestyle choices and good habits can lower the risk of developing a stress fracture, not only in the foot, but in other bones as well. He said people should support their bone health with adequate consumption of calcium and vitamin D. He has seen many patients who were found to be deficient in vitamin D, which can also affect healing. 

Drakos also stressed the importance of wearing supportive shoes.

“Flimsy footwear such as flip flops or ballet slippers do not provide adequate support,” he said. “We take more than a million steps a year. So, if you take 5,000 to 10,000 steps a day in shoes that aren’t giving you a lot of support, it’s that much extra stress on your feet with every step you take.” 

—Submitted by Hospital for Special Surgery

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