Stress Fracture of the Heel
Stress fracture is a painful microscopic reorganization of bone. Most stress fractures occur in the foot and follow a period of increased activity. Usually they are preceded by beginning a new exercise routine, working overtime, running a marathon or following a vacation where an unusual amount of walking is done.
There is generally a reluctance to bear weight on the affected bone. Someone with a stress fracture of the heel will tend to walk on the forefoot. There may be aching at night or at the end of a long day.
Diagnosis is made by taking a careful history and doing a physical exam. X-ray is usually negative for the first one to two weeks, but either a bone scan or an MRI will show positive within about 48 hours. There is also a "pre-stress fracture syndrome" where a bone is starting to hurt but does not ever fully manifest on X-ray. Pre stress fracture syndrome requires a shorter duration of treatment.
Treatment is immobilization and non weight bearing and this can be done in a variety of ways. The goal is to heal the stress fracture while maintaining the requirements of daily living. The use of a removable fracture boot with inflatable air bellows on both sides of the leg is one of the best types of treatment. Inflating the air bellows can transfer about 30 percent of the weight to the surface of the leg and the inside of the boot can be customized in the office to further "unweight" the affected bone. The removable cast boot can be taken off for sleeping, showering and driving. The more completely that weight is taken off of the healing bone, the faster the bone will heal. The range for non or partial weight bearing treatment is two or three weeks for a pre stress fracture and up to twelve weeks or more for a fully expressed stress fracture. Longer healing times are usually the result of not being able to keep weight off of the affected foot because of the demands of a difficult job. Stress fracture of the heel requires a more stringent treatment regimen of non weight bearing than does the stress fracture of a forefoot bone.
Posted by Mark A. Kuzel, DPM, FACFAS on September 10, 2010