Synonyms in a broader sense
Fatigue fracture, stress fracture, march fracture, insufficiency fracture
Definition/Introduction
A fatigue fracture of the foot is a creeping fracture of the bone (fracture), which occurs due to overloading, frequent, one-sided or constantly repeated loading (cyclic loading). It develops over a longer period of time. However, the force acting on the foot during overloading is not sufficient to cause the bone to break suddenly, as is the case with an acute fracture.
Therefore, the exact time of the fracture is often not noticed. The causes of a fatigue fracture of the foot lie in an insufficient adaptation of the bone tissue to the load and subsequently lead to an unnatural (unphysiological) bone resorption at the loaded area. If constant overloading occurs, small, as yet unnoticed fractures (microfractures) follow initially, but if the excessive load or incorrect loading continues, or due to inadequate compensatory mechanisms of the bone, these fractures spread further and ultimately lead to a fatigue fracture.
If this is a healthy bone, it is referred to as a stress fracture. Since the foot is a heavily loaded part of the body, it is considered particularly at risk for a fatigue fracture. Frequently, unusually heavy walking or running loads, such as when running/jogging or with soldiers, lead to a fatigue fracture.
In most cases the metatarsal (Os metatarsale) is affected. A fracture of one or more of the five metatarsals (usually the 2nd, 3rd or 4th metatarsal) is called a marching fracture. Jones’ fracture, on the other hand, is a fatigue fracture of the 5th metatarsal.
We have written completely separate topics for fatigue fractures of the metatarsus and heel: Fatigue fracture of the metatarsus and fatigue fracture of the heel Sudden changes in training in the form of a strong increase in distance or speed as well as long (>32 km), very hard or uneven running distances are possible risk factors for the development of a fatigue fracture of the foot. Foot malpositions or incorrect loading can also cause a fatigue fracture of the foot in the long run. A notable foot malposition is, for example, the hollow foot (Pes excavatus), which causes increased stress on the back of the foot (instep), the ball of the foot and the toes during running.
This can promote a fatigue fracture. In addition to the excessive load, bone diseases can also cause fractures of this type. In this case, there does not have to be an excessive load on the bone.
Such diseases are on the one hand osteoporosis, a typical disease of old age, in which the bones lose their strength and are much more susceptible to fatigue fracture due to their porosity. Mostly affected are women with menstrual disorders or those who are in or after the menopause. In these women, the bone substance is broken down due to a reduced production of female sex hormones (estrogens).
On the other hand, there are diseases such as rheumatoid arthritis (an autoimmune disease that can also affect bones and joints) and Paget’s disease (a bone-degrading skeletal disease) as well as rickets (a decrease in bone substance caused by a vitamin D deficiency). In these cases one speaks of an insufficiency fracture, i.e. a fatigue fracture of an already diseased bone. Bone tumors or metastases from tumors in a foot bone can also cause a fatigue fracture.
In addition, a prolonged intake of bone-decomposing drugs such as the anti-inflammatory drug cortisone increases the probability of suffering a fatigue fracture. Normally, a fatigue fracture is caused by a heavy sporting load, such as intensive jogging. In overweight people, however, a fatigue fracture can also occur during everyday life, for example, through prolonged running in the city or on vacation. The heel and metatarsus are often affected. If a fatigue fracture occurs due to excessive body weight acting on the bone, long-term weight reduction should be considered.
