Stress Fracture of the Foot

• Updated on: 2019-09-01
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A stress fracture is generally an overuse injury. It occurs when muscles become fatigued or overloaded and cannot absorb the stress and shock of repeated impact. Tired muscles transfer that stress to the nearest bone and the result is a small crack, or fracture, in the bone.

Most stress fractures occur in the second and third metatarsals in the foot. These metatarsals and thinner and longer than the first metatarsal. This part of the foot takes the most impact upon pushing off to walk or run. Stress fractures can also occur in the calcaneus, or heel, and the navicular, a bone on top of the foot.
What Causes a Foot Stress Fracture

Stress fractures in the bones of the feet are usually due to overtraining and overuse. Bones in the lower leg and foot are particularly susceptible to stress fractures because they are weight-bearing bones. This type of injury is most common among runners and athletes who participate in running and high impact sports, such as soccer, gymnastics, volleyball, and tennis. In all of these sports, the repetitive stress of the foot strike from running and jumping on a hard surface causes trauma and muscle fatigue. Without muscle strength, the right shoes and adequate amounts of rest between workouts, an athlete can develop a stress fracture.

Stress fractures also tend to occur when people change up their physical activity. Trying out a new type of exercise, suddenly increasing the intensity or length of workouts, wearing worn out, flimsy footwear or changing your running surface can all lead to a stress fracture. Additionally, diseases such as osteoporosis that has already weakened the bones make this injury more likely to occur just by doing everyday activities.

Women seem to be at a greater risk of developing a foot stress fracture than men. This could be related to a condition known as "the female athlete triad," which is a combination of poor nutrition, eating disorders and amenorrhea, or an infrequent menstrual cycle. This predisposes women to early osteoporosis, which decreases bone density and makes injury more likely.
Symptoms

Pain is the most common symptom of a stress fracture. Any kind of weight-bearing activity, even walking, makes pain worse. Other symptoms include:

Pain during normal, everyday activities
Pain that subsides during periods of rest
Swelling of the foot
Bruising
Tenderness

Treatment

If you suspect a stress fracture, see your doctor as soon as possible. Ignoring the pain can lead to serious consequences. In fact, the bone can break completely. A doctor can usually diagnose a stress fracture based on the patient's medical history, symptoms, and a physical examination. An X-ray or MRI may be ordered to confirm the diagnosis.

Treatment of a stress fracture usually involves R.I.C.E. therapy: Rest, Ice, Compression and Elevation. In many cases taking a break from your routine and incorporating low impact exercises will help the bone heal. Sometimes doctors recommend protective footwear and casts. Most stress fractures don't require surgery.

Most foot stress fractures take 6 to 8 weeks to heal completely.

Once the stress fracture is completely healed and you are pain-free, your doctor will allow you to return to activity slowly, perhaps alternating between days of activity and days of rest. The bones need time get used to pressure again. If proper recovery techniques are neglected, chronic problems such as larger, recurring stress fractures can develop, and the stress fracture may never heal properly.
Prevention

Stress fractures are preventable. These tips can help protect you from developing a stress fracture in the first place:

Eat well. Build stronger, healthier bones by maintaining a diet rich in calcium. This is especially important if you are female.
Progress slowly. Increase the intensity of your workouts gradually over time. Follow the 10 percent rule to avoid injury.
Wear the right shoes. Your shoes should fit and feel supportive. They shouldn't be flimsy and worn out. Make sure to replace shoes as necessary.
Acknowledge pain. If you experience any pain or swelling, stop the activity and rest for a few days. If pain persists, see your doctor.