If you are a runner/or walker and experiencing continued pain on the top of your foot you may be suffering from a stress fracture. Women seem to be more susceptible to stress fractures of the feet. Factors that predispose women more than men include a history of amenorrhea (lack of menustral cycles), osteopenia of bone, too small of body mass in the legs, and diet that may be too low in calcium.
The most common site of stress fractures that we see in our practice is the metatarsal bones in the foot. Additional factors that can contribute to stress fractures are worn out shoes, speed training, changes in running surfaces, and overtraining. Just this week I was able to diagnose two patients with stress fractures. These two patients actually were not runners but recently went to Disney world and did a tremendous amount of walking in flip flops. The combination of the long distance walking and the wrong shoes caused a hairline fracture in the metatarsal bones of the foot.
Clinically patient that I see will have pain and swelling on the top of the foot for more than two weeks. Initial x-rays may not show a stress reaction of the bone. It can take 10-14 days for a stress fracture to show up on a X-ray. In about three to four weeks bone callus (thickening of the bone) will indicate a healing stress fracture. It takes 6-8 weeks for a stress fracture to heal. We will place patients in a cam walker boot or surgical shoe in order for the bone to properly heal.
To decrease your risk for developing stress fractures replace your shoes every 300-400 miles, try to run on softer surfaces, and increase your calcium intake. You can do low impact exercises such as swimming and biking during the healing phase. It is very important to not run through the pain which can delay the healing time of the fracture.
In conclusion if you are experiencing pain and swelling on the top of the foot and it is not improving in two weeks with rest, ice, and NSAIDS, have it evaluated as soon as possible in order to correctly diagnose your foot condition. This will enable you to return to your chosen athletic activity sooner and not suffer through a chronic injury.