If you are like many Americans, this is the time of year to contemplate life and your place in the universe. Okay, maybe not the latter, but the former will usually involve thoughts on one’s health. Typically, this includes evaluating your fitness levels with grand plans to “get into shape”!

How many New Years resolutions involve an exercise program, with dreams of a “new you,” fit and toned, svelte even? Perhaps you are thinking you will buy that treadmill for your basement, with plans of running your way to heart-health, or trimming that expanding waistline? Gym memberships reliably increase around this time, as do the sale of home treadmills. Many will attack this new plan for fitness with, dare I say, fervor? Unfortunately, their bodies may not be up to this new intensity.

A common scenario would be that of this fellow I know named David, who once was fit and athletic. David longs for the body he had back then. He is on the far side of middle age and has enjoyed the “good life”. This is my code word for the fact Dave eats too much. And it shows. Still, he wants that old body, at least one a little closer to it. He joins a local gym, and come early January, he hits the treadmill. Literally, step after step.

This brings up an associated topic, that of bad shoes. Often, this means old shoes, and that’s what David was using. Step by step. In old, collapsed, tired shoes. Do you know much about the life span of an athletic shoe (aka tennis shoes, sport shoes, aka sneakers, etc)? It’s bad! They lose their cushioning ability, as well as any stability they may provide. This means more stress and impact to the foot.

A week into his workout plan, he noticed a pretty intense, burning pain in his left foot. Rest and ice did not do much, so he went to a walk-in health center. The P.A. at the clinic took an x-ray but saw nothing wrong. The anti-inflammatory she prescribed certainly helped with the pain as did the rest that was recommended. But again, his first steps in the morning were rather uncomfortable.

I suspect that a few of you out there in the reading audience have an inkling of the diagnosis, likely through personal experience. This sudden increase in physical stress to the 3rd metatarsal bone lead to a small crack in the bone. Like David’s, most stress fractures are caused by overuse and repetitive activity and are common in runners and athletes who participate in running sports. They are sometimes called march fractures because they were common in soldiers who were on the march, for long distances, generally in boots with inadequate support.

But Dave didn’t know any of this. He simply knew his foot hurt. He remembered using ice in his athletic heyday and doing so for this new problem definitely reduced the pain when he walked. Still, he realized it probably wouldn’t heal the injury…..whatever it was. Time to seek professional help. His family physician didn’t see anything either, when he took x-rays. He was then referred to me, an appropriate referral, a foot and ankle physician, also known as a podiatrist.

If you are wondering how I was able to diagnose David’s problem, a discussion on the anatomy of a metatarsal stress fracture is necessary. Because it is really just a crack in the hard, outer shell of the bone, there is minimal change in alignment or loss of the calcium composing the bone, which is the substance which stops x-rays. Thus, stress fractures are notorious for being difficult to identify with standard radiographs (the technical term for x-rays).

Sometimes, this condition is, by necessity, a diagnosis of suspicion. If the typical symptoms are present, the expected findings, one can treat the painful foot as though it is a stress fracture. This is the safe approach. Plain film radiographs will show changes eventually, with x-rays revealing the development of bone callus, an enlargement of the bone at the site of the fracture. Its almost as though the bone is building its own internal cast of bone, for the bone.

Sometimes, an individual with a stress fracture will be able to bear weight, to stand and to walk. Let’s strike down that old wive’s tale once and for all. You CAN walk with a broken foot. When examined, the afflicted foot will be a little swollen, maybe slightly reddish, and painful with “manipulation”. Other than that, there are no blood tests or physical findings that will provide a definitive diagnosis. The gold standard of tests for diagnosing a stress fracture is an MRI. If you have been living in a cave for the last decade, you may not have heard of the challenges of modern-day health insurance. Getting an MRI study approved by your health insurance can be very difficult, if not impossible.

So I gave David the boot! Kicked him right out the door! No, of course not, I gave him a removable cast boot as the primary form of treatment. This is, of course, immobilization. There are many forms, although the walking boot of today, referred to as a cam boot (Controlled Ankle Motion), has taken over the market. Casts are still used, but less often with CAM boots so convenient. Many traumatic fractures require surgery to stabilize the break, but stress fractures of the metatarsals rarely require surgical intervention.

Some unfortunate individuals experience more than one stress fracture. This can be the result of their foot type, which ultimately determines their lower extremity mechanics. For example, an arch which rolls too much will place excessive stress on the metatarsals. Thus, for people with a biomechanical cause, foot orthotics can prevent this painful injury. A tight Achilles tendon is another possibility, pulling up on the heel as it does, resulting in more force experienced by the ball of the foot.

There are many ways to enhance bone healing, of course. Bone stimulators are available, with one of them producing a magnetic field to help with healing. Although not as powerful, static magnets can be purchased to utilize this effect, of a magnetic field on bone healing. This method can be used with a stress fracture in the foot, as well.

David healed up with a month in a boot, so there’s no fascinating treatment technique to talk about here. In summary, successful treatment starts with an accurate diagnosis. As with so many orthopedic issues, treating the wrong problem probably won’t provide the best results. But many conditions in medicine require a “high index of suspicion” to diagnose. This is one of those kinds of injuries; you must be intimately familiar with it to know what it is. For athletes, the goal is to get them back to their activity as quickly as possible (although it’s always too long for the devoted athlete). But for most, some type of immobilization is the answer to treatment. Not difficult, once you have been given the correct diagnosis.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.