Stress Fracture Versus Stress Reaction of Bone

 

Stress fractures in the foot and metatarsals (forefoot) are quite common. There’s almost always swelling of the forefoot and often there is pain. It is most common with the second metatarsal but it can also involve the third or fourth metatarsals. The first and fifth and metatarsals are much less common.


With a stress fracture there is bone fatigue to the point, that there’s a break in the outer shell or cortex of the bone. But it’s a hairline break in the body usually is able to try to protect it and start the process of healing. The body‘s way to heal this is to form a bone callous adjacent to the break in the bone. The bone callous becomes is visible on x-ray where as the original fracture is such a fine hairline break that often you cannot see it on x-ray. With enough time or activity the fracture outer shell cortical fracture or break can progress to a displaced fracture that is now a visible fracture on x-ray. 

 

On the other hand, with a stress reaction of bone there is not a break in the cortex of the bone and the bone callous therefore never develops. But inside the bone there is still marrow edema. This means that the bone has increased activity and literally swelling within the bone. With both a stress reaction of bone and a stress fracture there is marrow edema that can be seen with an MRI - for early detection of both conditions. Ultrasound imaging can often show a stress fracture early, but not a stress reaction of bone.


Functionally both conditions are quite similar since they both involve bone healing. Typical bone healing for an adult is eight weeks. If you have pain in your feet or swelling, please make an appointment for a consultation at our clinic or give us a call at 425-391-8666.

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