The term march fracture was first applied to leg fractures to the tibia or shinbone of soldiers during the 1855 Crimean War, as a result of the harsh marching conditions. Today, this type of injury is generally referred to as a stress fracture. Athletic activities such as running, tennis, football, and basketball are the most common causes. March fractures can occur elsewhere in the body as well.
How Do March Fractures Happen?
A sudden change in activities, such as increasing workout intensity, or jogging outdoors with no conditioning are two of the most common causes of march fractures. People diagnosed with osteoporosis or other conditions that cause weak bones are prone to these fractures, sometimes caused by simple daily activities. A wrongful step or sudden impact can cause march fractures, as can high heeled shoes. The bones of the lower leg and foot bear the weight of the entire body; these body parts absorb the impact of repetitive forces such as running, walking, or jumping, and this makes them most vulnerable to march fractures. With the addition of factors such as extra weight or the introduction of new activities without proper warmup, the likeliness of developing these types of fractures increases.
Walking with March Fractures
Walking with a march fracture can be painful, depending on the degree of injury. People with minor fractures feel mild discomfort, while more severe injuries can cause excruciating pain. Swelling usually occurs at the top of the foot or around the ankle, with pain intensifying during normal activities. Sports medicine specialists such as orthopedists can evaluate the severity of the fracture and prescribe the best device to aid walking.
Home Treatment of March Fractures
The first step is to refrain from the activity that caused the injury. Delaying a doctor visit increases the risk of developing a complete fracture that will take longer to heal, but following the RICE protocol until your doctor’s appointment will render some relief:
- Rest: avoid activities that put weight on your foot. Use a supportive shoe if you need to bear any weight.
- Ice: apply cold packs immediately to help reduce swelling.
- Compression: lightly wrap the area with a bandage reduce additional swelling.
- Elevation: rest with the injured body part raised higher than your heart.
Anti-inflammatory drugs help alleviate pain and reduce swelling. The doctor will determine the best course of action, which may include physical therapy, immobilization, or a walking boot, crutches, or other devices
What is Remodeling?
Our bones go through a process called remodeling. This is best described as a perpetual state of turnover, where new bone growth replaces older bone. Pushing the body too hard accelerates the breakdown of older bone. This surpasses the rate of new bone growth and this affects the body’s ability to repair itself, increasing the bone’s vulnerability to march fractures.
It’s All About Conditioning
One of the most common causes of march fractures is doing too much too soon, without proper conditioning. This most often occurs with newcomers to exercise programs; however, experienced athletes may develop them as well. The latter typically cut back on training over the winter months and, come springtime, are anxious to get right back into their old routine. The most common mistakes are not pacing themselves and resuming their previous pace, ignoring the discomfort. The bodies do not get enough time to heal, leading to march fractures.
Techniques, Surface, and Equipment
- Wrong technique: Bunions, blisters or tendonitis can result in placing weight on the foot in an unnatural way, causing those bones to absorb more weight than normal.
- Changing the surface: Changes in the training surface can increase the risk for march fractures. For instance: going from a treadmill to a paved track, or going from a paved track to rough terrain.
- Proper equipment: Ensuring footwear matches the type of activities and than shoes have proper shock absorption will help avoid these types of injuries.
Getting sidelined for march fractures can be very frustrating. Most fractures of this nature heal in six to eight weeks. Following the doctor’s care plan is paramount, as returning to former activities too quickly will jeopardize the healing process and put one at risk for more serious injuries that will take longer to heal.
Physical Therapy for March Fractures
Relief for pain from a march fracture is the main reason for seeking medical attention. A therapist will use a variety of treatment options to reduce inflammation and pain, including electrotherapy (TENS Unit), ice, soft tissue massage, acupuncture, and sports tape. At-home strengthening exercises are also an important part of any treatment plan.
Bruising and Swelling
When blood vessels in the surrounding tissue or bone are damaged, blood can leak into the injury site. The size and color of the bruise will change over the next few days, which generally indicates healing. As the blood is reabsorbed, the bruise will shrink, eventually disappearing. This does not necessarily mean the bone has healed, as this generally takes longer. Swelling at the injury site may be indicative of inflammation and infection. Additionally, the body allows fluid build-up around the injury as cushioning, starting almost immediately and increasing over the first hours.