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Stress Fracture of the Foot

Dr. Matthew Garoufalis

Reviewed by
Dr. Matthew Garoufalis

Stress fractures can occur to any bone in our bodies, but our feet are the most common location. This type of fracture can happen to any of the foot bones, but it mainly occurs to the second and third metatarsal bones, in the heel, and in the navicular bone. Stress fractures are the result of repetitive abuse, or repeated application of stress to the bones—hence the name. Our feet, which hold all of our body weight, are under continuous stress every day, making them particularly susceptible to this type of injury. Stress fractures are sometimes described as small cracks or hairline fractures in the bone.

Stress FractureOur muscles act as shock absorbers. When they are fatigued or overloaded, they cannot absorb the shock and stress of repeated impacts, and end up transferring the stress to nearby bones. Over time, the bones begin to weaken and become prone to fractures and cracks. Athletes of all kinds are susceptible to this injury, but runners seem to be more prone than other groups. Women seem to be at greater risk of foot-stress fractures than men due to a condition called “the female athlete triad,” which is a combination of eating disorders, poor nutrition, and infrequent menstrual cycles. This condition is known to thin the bones—a process called osteoporosis—and results in decreased bone density and increased risk of stress fractures in the feet.

Stress Fracture of the Foot Symptoms

There are a few symptoms to watch for if you think you may have a stress fracture in your foot:

  • Pain that develops gradually and becomes severe even during normal daily activities
  • Pain when applying weight
  • Pain that goes away after resting
  • Tenderness to the touch
  • Occasional bruising
  • Swelling on the top of the foot or outside of the ankle

You should be able to wiggle your toes and move your foot and ankle around with a stress fracture injury to the foot. Many people believe stress fractures immobilize sufferers, and when they are not immobilized, they fail to take the injury seriously enough to seek treatment. Many runners who have suffered stress fractures say they did not realize the seriousness of the problem until the pain was unbearable. They would run on their injured foot for months, or even years, before seeking medical attention. Many sufferers are fooled when their pain diminishes as they exercise, then returns once the exercise is over.

What Causes a Stress Fracture?

Stress fractures are caused by repetitive impacts sustained over time, combined with fatigued muscles that become unable to absorb the stress and shock of each impact. But there are other factors, such as how often you exercise, how long you exercise, and your level of exercise intensity. All these affect how much stress you put on your lower leg muscles and feet. You do not have to be athletic to suffer a stress fracture in your foot. Older women are more susceptible to osteoporosis and other diseases that weaken bones. Even normal household activities can create stress fractures.

Other causes of stress fractures in the foot include:

  • Type of footwear
  • Type of equipment you use to exercise
  • Type of surface you exercise on (concrete, grass, turf, wood, etc)
  • Brittle bones
  • Bunions, corns, and calluses, which may alter your gait, which in turn may alter the manner in which you apply stress to your foot with each step
  • Female athletic triad
  • Rheumatoid arthritis
  • Insufficient rest periods
  • Continuing to train despite pain
  • Neuropathic foot
  • Osteopenia/osteoporosis

When Should I See a Doctor?

If you suspect you have a stress fracture in your foot or ankle, you should stop your activity and not apply pressure to the injured foot. Do not ignore the pain, especially if it is coupled with the symptoms listed above. If you try to walk on the foot or ignore the symptoms, you could break your foot completely. Instead, apply an ice pack and elevate your foot above the level of your heart. If possible, take ibuprofen or naproxen to relieve the pain and swelling (this may not help at all if the injury is severe). Be aware of the risks involved with taking an NSAID (nonsteroidal anti-inflammatory drug) like ibuprofen in a situation like this, as such drugs may inhibit bone healing. Call your doctor to make an appointment for a diagnosis. If the fracture is caught early, the damage may be minor and easily treated

Diagnosing a Stress Fractured Foot

If you think you have a stress-fractured foot, you need to see a podiatrist. Your doctor will ask you questions about your activities, dietary habits, medical history and anything else that may help him or her evaluate your risk of a stress fracture. He or she will also inquire about your symptoms and perform a physical examination. To get a better understanding of what is happening inside your foot, imaging tests may be necessary. X-rays and MRI (magnetic resonance imaging) scans can detect a stress fracture in its early stages. MRI scans are more sensitive than x-rays, which can only detect stress fractures after the healing process has begun.

Stress Fracture of the Foot Treatment

Most stress fractures happen to active people. Stress fractures need plenty of time and rest to heal. Healing is delayed and prevented by continued weight applied to the fracture during the healing process. Your healing time will depend on the severity of the fracture, the location, your body’s ability to heal, and your dietary habits. Once the stress fracture heals and you are pain-free, you will slowly be able to resume your activities. In most cases, recovery takes four to six weeks of rest and immobility.

Crutches, walking boots, and casts are used to prevent a patient from putting weight on the injury. Patients are advised to keep weight off the foot at all times. In severe cases, surgery may be necessary to ensure that the bones heal properly, and a wheelchair may be required. This could lengthen recovery time up to eight weeks or more, depending on the severity of the injury and the type of treatment needed.

TIP: Stress fractures in the foot tend to begin healing rather quickly, and symptoms diminish. This prompts some patients to resume normal activities too soon, before the stress fracture has actually healed. This can result in delayed healing and could possibly worsen the problem. Always consult your doctor about changes in your condition, even improvements.

Preventing Stress Fractures in the Foot

According to the American Orthopaedic Foot and Ankle Society, the following list of guidelines should be used to prevent stress fractures in the foot:

  • Consume plenty of Vitamin D and calcium-rich foods to strengthen your bones.
  • Use proper sports equipment.
  • Throw away old, worn-out shoes and socks.
  • Only wear shoes that fit you properly and offer enough support.
  • Alternate your activities. For example, swim one day and run the next.
  • Start new activities slowly. For example, if you are not a runner, do not start a new running routine by going on a five mile jog. Instead, start with a quarter mile to a mile for the first week, and then build up.
  • Do strength-training exercises to prevent muscle fatigue.
  • If you are aging, talk with your doctor about preventing bone-density loss.
  • If symptoms return, stop your activity and rest for two or three days. If symptoms persist, call your doctor

Questions to Ask Your Doctor

Here are some questions to ask your doctor if you have suffered a stress fracture in your foot:

  • Does their practice offer any type of custom-made orthotics? If so, how quickly can those devices be made, and are they affordable or covered by insurance?
  • Can I use my dad’s old crutches that he left at my house to stay mobile?
  • I do not have a bathtub, only a stand up shower; will I still be able to bathe normally?
  • How much pressure can be applied to the foot when I am walking?
  • What are the chances of this injury recurring?

You may have additional questions for your doctor. If possible, make a list before your first appointment. To talk to a podiatrist via e-mail right now, visit the American Podiatric Medical Association’s web site at http://www.apma.org/

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Medical References:

  1. M. Beers "Merck Manual of Medical Information" 2nd home edition (Pocket Books, 2003) 353-354
  2. American Medical Association "Family Medical Guide" 4th Edition (John Wiley & Sons, Inc. 2004) 982
  3. H. Winter Griffith, MD "Complete Guide to Symptoms, Illness & Surgery" (The Berkeley Publishing Group, 2006) 313
  4. American Academy of Orthopaedic Surgeons, Stress Fractures of the Foot and Ankle, http://orthoinfo.aaos.org/topic.cfm?topic=a00379

This page was last updated on December 17th, 2014



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