Foot and Ankle Specialist in Singapore

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What are Stress Fractures Of The Foot and Ankle?

A stress fracture in the foot or ankle is a small crack in a bone, or in some cases, severe bruising within a bone. This condition typically affects the weight-bearing bones of the lower extremities, such as the second and third metatarsals in the foot, which are more vulnerable due to their thinner structure.

These types of fractures most commonly occur as a result of repetitive forces absorbed during activities like walking and running.

Causes of Stress Fractures Of The Foot and Ankle

Stress fractures of the foot and ankle are predominantly caused by overuse and repetitive stress on the bones. Several factors contribute to the development of these fractures:

  • Bone Density Issues
    Conditions like osteoporosis, which decreases bone strength and density, make bones more susceptible to stress fractures. The reduced bone density means that even normal levels of stress can cause fractures.
  • Sudden Increase in Physical Activity
    Engaging in new or intensified physical activities without adequate preparation or conditioning can lead to stress fractures. The bones may not have enough time to adapt and recover from the increased demands.
  • Repetitive Physical Activity
    Continuous, repetitive movements, particularly in activities such as running or dancing, place ongoing stress on specific areas of the foot and ankle. Without sufficient rest and recovery, this can lead to the development of stress fractures.
  • Abnormal Loading of the Foot
    Foot deformities, including high arches and flat feet, alter how weight and pressure are distributed across the foot and ankle during movement. This can result in stress fractures.
  • Inadequate Footwear
    Footwear that lacks proper support or has diminished shock-absorbing capabilities can contribute to the development of stress fractures. Proper footwear plays a role in distributing forces evenly across the foot.
  • Change in Walking Surface
    Transitioning from one type of surface to another, like from a soft to a hard surface, can increase the risk of stress fractures due to the different levels of impact absorption.

Symptoms and Signs

Stress fractures are characterised by several symptoms and signs, which can vary based on the location and extent of the fracture.


  • Pain During Physical Activity: The primary symptom is pain, which typically intensifies during physical activities such as walking, running, or jumping, and tends to decrease with rest.
  • Persistent Pain: In some cases, the pain does not subside entirely even after stopping the activity, and may become more noticeable when resting.
  • Pain That Worsens Over Time: Initially, the pain might only be present during or after strenuous activities but can progress to a constant ache as the condition worsens.
  • Localised Tenderness: The area around the stress fracture is often tender to touch. This is usually localised to the site of the fracture.
  • Swelling: Swelling may be observed on the top of the foot or the outside of the ankle, depending on the fracture’s location.

Diagnosis

The diagnosis of stress fractures in the foot and ankle involves a thorough evaluation by a foot and ankle specialist.

  • Medical History and Physical Examination: The initial step involves a detailed discussion of the patient’s medical history and general health to identify potential risk factors. A physical examination assesses tenderness, swelling, and other signs in the foot and ankle area.
  • Imaging Tests: X-rays are often utilised to confirm the diagnosis and assess the severity of the fracture. While they may not immediately show stress fractures due to their subtlety, they can reveal changes in bone that indicate healing from a fracture. An MRI or bone scan may also be performed in some cases, to provide more detailed information.

Non-Surgical Treatment Options

Non-surgical treatments are often the first line of approach for stress fractures of the foot and ankle. These aim to relieve pain, support the healing process, and prevent further injury.

Rest and Activity Modification

Initially, the foot and ankle specialist may suggest reducing or ceasing activities that put weight on the affected area. This is intended to allow the bone time to heal. Activities that involve high impact or stress on the foot and ankle should also be avoided or reduced.

Protective Footwear

Wearing shoes that provide proper support and cushioning can help alleviate stress on the fracture site. In some cases, specialised footwear or orthotic devices may also be recommended.

Crutches, Walking Boots, or Casting

In more severe cases, these tools may be used to offload weight from the affected foot and ankle to aid in healing.

Physical Therapy

After a period of rest, physical therapy can help gradually rebuild strength and mobility in the foot and ankle.

Anti-Inflammatory Medication

Over-the-counter anti-inflammatory drugs may be used to manage pain and reduce swelling. These should be used with caution, as they occasionally impair bone healing.

Surgical Treatment Options

In cases where non-surgical treatments for stress fractures of the foot and ankle are insufficient, or if the fracture is severe, surgical intervention may be required.

Internal Fixation

This is a common surgical procedure for stress fractures that have not healed adequately with conservative treatment. It involves the use of surgical hardware such as pins, screws, or metal plates to secure the bones in the correct position, allowing them to heal properly.

Bone Grafting

In some instances, particularly when there is a large gap or poor bone quality, a bone graft may be necessary. This involves transplanting bone tissue to promote healing and provide structural support to the fractured bone.

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Prevention Strategies

Making lifestyle adjustments and being aware of risk factors may help in reducing the risk of stress fractures.

  • Gradually Increasing Physical Activities - Avoid sudden increases in the intensity, duration, or frequency of physical activities. Gradually building up your exercise routine can give your bones time to adapt.
  • Proper Footwear to Support the Feet and Ankles - Wear supportive and well-cushioned shoes, especially during high-impact activities. Replace athletic shoes regularly to ensure adequate shock absorption.
  • Strength and Flexibility Training for the Foot and Ankle - Incorporate exercises that strengthen the muscles and improve flexibility around the foot and ankle. This can help absorb and distribute forces more effectively during physical activities.
  • Adequate Nutrition - A diet rich in calcium and vitamin D may support bone health, although dietary needs can vary.
  • Cross-Training When Engaging in Exercise - Engage in a variety of physical activities to distribute the stress of exercise more evenly across different parts of the body. This reduces the risk of overloading any single area.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Can I Continue Exercising With a Stress Fracture?

    Engaging in exercise or weight-bearing activities with a stress fracture in the foot or ankle should be approached with caution. Continuing physical activity may exacerbate the injury, potentially leading to more severe fractures or prolonged recovery. Consult a foot and ankle specialist before resuming any physical activity, to explore options that work for your specific condition.

    How Long Does a Foot or Ankle Stress Fracture Take to Heal?

    The healing time for a foot or ankle stress fracture varies depending on several factors, including the fracture’s severity, location, and the individual’s overall health. Typically, it can take from 6 to 8 weeks for a stress fracture to heal adequately.

    What Happens If You Ignore a Stress Fracture in Your Foot or Ankle?

    Ignoring a stress fracture in the foot or ankle can lead to complications, such as the fracture becoming more severe or developing into a chronic condition. Early diagnosis and treatment may contribute to better healing outcomes and could help in preventing further damage.

    How Are Stress Fractures Different from Other Types of Fractures?

    Stress fractures differ from other types of fractures in that they are usually caused by overuse or repetitive activity, rather than a single traumatic event. They often appear as small cracks or severe bruising within a bone, particularly in weight-bearing bones of the foot and ankle. Unlike acute fractures that result from a specific injury, stress fractures develop gradually and are often associated with increasing levels of physical activity or changes in exercise routines.