Stress Fractures of the Foot

What are stress fractures of the foot?

A stress fracture is a very small, fine break in the bone caused by continuous or sudden overuse. While stress fractures can occur in many bones that are subjected to repetitive activities, the bones of the legs and feet are at greatest risk. The bones in the midfoot (metatarsals) in runners are especially at risk for stress fractures.

What causes stress fractures of the foot?

A sudden increase in physical activity is often the cause of stress fractures in feet. The increase can be either in the frequency or the intensity of movement. Examples include such things as suddenly increasing the number of days you exercise or running 3 miles instead of your usual 1 mile. Stress fractures often occur in the foot after training for basketball, running, and other sports. They are common in military recruits.

People who are not athletes can also get stress fractures. New shoes that fail to absorb repetitive walking forces can lead to stress fractures. Stress fractures also occur in people who walk long distances or on uneven ground. Sudden physical activity after a period of inactivity may also cause stress fractures. Reduced sensation in the feet due to nerve damage (such as due to diabetes) may raise the risk of stress fractures. Weak bones due to osteoporosis or joint inflammation (arthritis) may increase the chance of having a stress fracture. Low vitamin D levels are linked with increased risk of fractures including stress fractures.

What are the symptoms of stress fractures of the foot?

Symptoms of stress fracture may vary depending on the site and severity of the fracture. They may include:

Pain in the front of the foot, often after long or intense activity
Swelling (may be absent in some cases)
Tenderness
Bruising
Pain that goes away after exercise, then returns when exercise starts again

The symptoms of stress fractures can be like other health conditions. Always see your doctor for a diagnosis.

How are stress fractures of the foot diagnosed?

Diagnosis of a stress fracture often is confirmed with a complete health history and a physical exam. X-rays often can’t see stress fractures because they are so fine. So a bone scan or an MRI may be done. Once the callus forms around the fracture, an X-ray can confirm a stress fracture.

How are stress fractures of the foot treated?

Treatment is aimed at easing pain and giving the fracture time to heal. This often takes about 6 to 8 weeks. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

Rest
Protection of the fracture site with reduced weight bearing
Cold packs
Medicine such as ibuprofen
Shock-absorbing shoes to use during activity
Running on soft surfaces, such as grass
Physical therapy
Switching to a less stressful activity, such as swimming or biking
Wearing a brace or cast

Prevention

Here are some tips from the American Academy of Orthopaedic Surgeons to help prevent stress fractures:

Build up gradually. When starting any new sports activity, set smaller goals. For example, don't set out to run 5 miles a day. Instead, slowly build up your miles every week. Include proper warm-up and cool-down exercises and stretches in your workout routine.
Cross-train. This means alternating activities that accomplish the same fitness goals. It can help prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility exercises to the mix for the most benefit.
Eat healthy foods. Make sure you have calcium- and Vitamin D-rich foods in your meals.
Use the correct equipment. Don't wear old or worn running shoes.
Watch out for pain. If pain or swelling occurs, stop the activity right away and rest for a few days. If continued pain persists, see an orthopedic surgeon.
Treat symptoms early. It's important to remember that if you recognize the symptoms early and treat them, you can return to sports at your normal playing level.

Key points about stress fractures of the foot

A stress fracture is a very small, fine break in the bone caused by continuous overuse.
The bones of the legs and feet are at greatest risk.
The bones in the midfoot (metatarsals) in runners are especially at risk for stress fractures.
A sudden increase in physical activity is often the cause of stress fractures in feet.
Treatment is aimed at easing pain and giving the fracture time to heal. This often takes about 6 to 8 weeks.
If you take the correct precautions when starting a new exercise program, you can prevent stress fractures.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also, know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.