What is the management of a stress fracture?

So can you please talk us through the management of a stress fracture of the foot? So the management starts with really taking a history from the patient, finding out what was the cause of the initial pain and see if it's related to a repetitive stress or repetitive strain such as training for a marathon or recently taking up running. So there's different causes and we need to find the underlying cause which will help us manage the patient because without them knowing the cause we can't actually treat this condition and then we would investigate the patient and the common way of investigating this sort of injury is to do an x-ray but sometimes the x-ray may not show the injury and we will then have to do further investigations such is an MRI scan so just looking at the monitor now so this is this is a stress fracture it usually occurs in any any of the metatarsals but the second one being the longest metatarsal is often involved here we've got a fifth metatarsal stress fracture and if if we look at the fracture or the x-rays on this monitor here on the left hand side you on the second metatarsal which is this bone here you can't actually see the fracture and at that stage if the patient was very symptomatic you may decide to proceed to an MRI scan. However if we repeat the x-ray in about four to six weeks time we see that there is loads of new bone formation which we call callus formation which proves that there was initially a fracture there but we just could not see it because of the resolution whereas an MRI scan would give us that answer straight away. Having made the diagnosis we then decide on how we're going to treat these fractures and I would say that overall pretty much all of these fractures are treated without an operation. We would treat these depending on its location either in a cast or in a boot most of the time they're treated in a boot and the patient is allowed to wait there. If for whatever reason the fracture did not heal and we would allow at least three months for the fracture to heal if for whatever reason it did not heal we would then consider surgical intervention and this surgery could be an open procedure where we plate the fracture and we may have to use some bone graft to supplement that or we may be able to do a percutaneous screw fixation which allows a bit of compression at the fracture site and stimulates bone healing. So if you look at this one there is a fracture line going through the 5th metatarsal and we've used a percutaneous screw i.e. a small nick on the outside of the toe and it's just passed along the edge of the toe into the toe which compresses the fracture site and causes it allows it to heal but in certain situations you can't do that and you have to do a formal operation but in summary most of these would be treated without an operation