Dr. David B. Raynor, Best Foot Forward, 02/05/13

A fracture is a break, interruption, or insult in a bone that disrupts its continuity. A break and a fracture are the same thing.

Break and fracture are just different words used and accepted to describe and mean the same thing as they apply to bone injury. However, there are certainly different degrees of fracture or break.

Fractures or anything that disrupts the covering of bone (the periosteum) cause pain. I tell patients that depending on the individual, a small insult to a small bone can hurt as much as a compound fracture.

The level of pain varies from individual to individual. I never tell a patient with a small toe fracture it “shouldn’t hurt that much.” Pain is pain, and tolerance varies from person to person.

A stress fracture is a fracture in the bone where the bone is still in alignment and is almost completely functional, but it hurts and is still “broken.”

I tell patients a stress fracture is usually an overuse injury whereby the stress of daily activity, exercise or a new activity outpaces the healing ability of a bone, and so the bone fatigues and eventually fails over a period of time rather then in one fell swoop.

I tell patients the fatigue is similar to bending a piece of metal many times and it will eventually fail and break.

A stress fracture is also similar to a crack in a windshield. You can see the crack so you know the windshield is broken. The cracked windshield still “works” in most cases, as it does its job. You can see through it and it keeps debris and weather from affecting you, but it is still broken as evidenced by the visible crack. A stress fracture is very similar in the foot, but it can be very painful.

Stress fractures can be difficult to see on radiographs, however.

Many times, I will tell a patient I believe they have a stress fracture, but none shows on radiographs. Their history and exam may be consistent with stress fracture, but the break may not be evident on radiographs. This often gives patients worry.

A negative radiograph does not rule out a stress fracture as they often take some time before changes show up on radiographs.

In my opinion, stress fractures should be treated when the suspicion is high, regardless of the lack of radiographic evidence. Repeating the radiographs in two weeks after initiating treatment is often enough time to see the fracture which reassures the patient.

More time, bone scan or MRI can be considered to see the fracture if the fracture is still invisible on radiographs as long as the patient is being treated for fracture and is feeling more comfortable with that treatment.

Stress fractures are painful and they can be difficult to observe on radiographs. Repeating radiographs over time with treatment or more definitive testing are acceptable alternatives for diagnosis if radiographic evidence is unobtainable.

If you have pain in your foot or ankle that does not resolve, you should consult with your podiatrist or family physician.

David B. Raynor, DPM, is a podiatrist in Inverness and can be reached at 352-726-3668.