What is a stress fracture?
A stress fracture is an overuse injury and generally occurs when an increased workload is placed on a bone over a period of time causing it to form small crack or fracture. Most commonly stress fractures occur in the lower leg and foot. In dancers a very common area for a stress fracture is in the long metatarsal bones of the foot, especially the 2nd metatarsal.
Common signs and symptoms of a stress fracture may include bony tenderness over the Metatarsals, swelling and redness, tenderness when walking on the foot especially first thing in the morning, pain over the metatarsal bones when rising onto demi pointe or when on pointe.
What Causes a Stress Fracture?
There are many causes of stress fractures most commonly in dancers they will occur from:-
- Rapid increase in level of activity without correct conditioning such as extra rehearsals for concerts
- Poor technique and strength, such as incorrect weight placement through the foot, poor calf strength or intrinsic foot control
- Repetitive impact on a hard surface i.e. jumping on a dance floor that is not sprung
- Wearing poorly cushioned shoes while walking (or dancing) on hard surfaces. This is a huge problem for dancers as ballet shoes tend to lack essential support. Poorly fitted shoes also add tremendous amounts of unnecessary stress to the bones of the foot.
- Abnormal foot structure, such as flat feet or extremely high arches.
- Eating Disorders (Malnutrition causing bone density to decrease).
Will it Recover?
Yes, given the correct treatment and support it should recover fully. By identifying and eliminating factors that contributed to the stress fracture in the first place this should stop it from re occurring.
Will I have to take time off dancing?
Yes, in order to allow the bone to heal a period of rest is recommended however there are many exercises and activities you can continue to do to maintain strength and fitness during this time. The bone should heal after approximately 6 weeks if treated well. However you may be able to get back into some basic class work earlier than this if appropriate.
What is the best treatment?
Treatment will vary depending on the severity and nature of the stress fracture. Often treatment may require the foot to be immobilised in a boot it for 2-6 weeks. Sometimes a period of non-weight bearing on crutches for 2 weeks is recommended. Rest, Ice, Compression and Elevation in its early stages can be beneficial to reduce any inflammation.
A strength and conditioning program to maintain stability and improve on any contributing weakness. This should include core, shoulder and hip stability exercises, as well as an effective flexibility program to maintain good range of movement. Supportive foot wear is recommended.
A slow progression back into dance class and other exercise. A balanced diet including vitamin D and calcium-rich foods is important in maintaining bone density and health. This is an ideal time to work on others areas of the body and improve technique so you will return stronger than before the injury.
Stress fractures are an injury commonly seen in dancers, specifically in the metatarsal bones of the feet. They generally occur when a bone is subjected to an increased work load without correct conditioning prior to commencement. Treated effectively you can make a full recovery back to dance and by maintaining good strength and technique you can avoid any long term issues or recurrences.