Stress Fractures: Identifying, Treating, and Preventing This Common Injury

As an athlete or fitness enthusiast, you naturally want to keep your body in good condition to enjoy your activities for a long time. However, being constantly on your feet, overtraining, and even using improper shoes can put you at risk of conditions that can impact your game, including stress fractures.  

Stress fractures are a common injury affecting athletes and fitness enthusiasts alike, often resulting from overuse or repetitive force on the foot and ankle. In this post, we delve into what a foot stress fracture is and how it occurs to help you better understand and prevent this condition.

What Is a Foot Stress Fracture, and How Does It Occur?

A stress fracture is a tiny hairline break that can occur in bones in the foot and ankle. Common causes of foot stress fractures include overuse or overtraining, improper shoes, flatfoot, or other foot deformities, including osteoporosis. 

Note that this condition doesn’t necessarily result from a fall or a high level of injury. In

stead, the bone eventually develops cracks due to stress from repetitive, low-grade pressure. Prime examples of this include activities like repetitive jumping or running long distances.

The bones in the body undergo remodeling, or the lifelong process of resorbing bone and replacing it with new ones. With too much stress and activity, older bones can break down more rapidly, outpacing the body’s ability to repair or replace them. When this happens, the bone becomes more prone to developing cracks. 

Risk Factors and Causes of Foot Stress Fractures

Numerous factors can increase the chances of developing a stress fracture in the foot and ankle: 

• Increased physical activity. People who abruptly shift from a sedentary lifestyle to an active training program or rapidly increase their training sessions’ intensity, duration, or frequency are more susceptible to stress fractures.  

• Sports. High-impact sports like basketball, tennis, track and field, and dance or gymnastics can lead to a significant increase in developing a stress fracture. 

• Gender. Women can be more prone to developing stress fractures mainly due to the types of shoes worn consistently. 

• Foot Type. People with a rigid high arch or flat heel are more likely to develop stress fractures in the foot and ankle. 

• Improper footwear. Wearing ill-fitting shoes or footwear that has lost its shock-absorbing ability can make stress fractures more likely to occur. 

• Osteoporosis. While overuse and overtraining and the leading causes of stress fractures, normal use of a bone is also a risk factor for individuals with conditions like osteoporosis. It can weaken the bones and make it significantly easier for cracks to develop. 

• Vitamin deficiency. Lack of vitamin D, calcium, and eating disorders can make bones more likely to develop stress fractures. 

• History of stress fractures. Having one or multiple stress fractures in the past can put you at a higher risk of having more. 

Symptoms of Stress Fractures

A foot stress fracture can exhibit itself in various ways, but pain, swelling, redness, and bruising are among its most common signs. 

The pain may begin with slight tenderness during running, training, or other physical activities. Eventually, the pain can become more noticeable after stopping your workout or while at rest. Your entire foot may hurt, but the area around the damaged bone will be the most painful and tender. 

On the other hand, swelling may be intermittent and then progress as the foot stress fracture worsens. 

Diagnosing Foot Stress Fractures

A foot and ankle specialist can diagnose a stress fracture based on your medical history and a physical exam. Imaging will also be required to confirm the diagnosis and area of concern. 

Your care provider may order the following imaging tests to verify if you have a stress fracture: 

• • An X-ray is commonly used to diagnose fractures. However, it doesn’t always show stress fractures, especially if it hasn’t been around two weeks since they developed. Still, it can detect a bone callus, which forms around the stress fracture over time and indicates that the body is healing the area. 

• A CT (computed tomography) scan is typically used for surgical planning of fractures, but its high sensitivity and specificity help catch large to minor stress fractures.  

• An MRI (magnetic resonance imaging) can be ordered if necessary. It can visualize low-grade stress injuries before an X-ray shows changes, as well as distinguish between stress fractures and soft tissue injuries. 

Stress Fracture Treatment Options

The treatment of a stress fracture can depend on its severity. However, the good news is that nearly all cases can be treated with conservative or nonsurgical approaches. 

Here are some conservative treatment options for addressing foot stress fractures:

• RICE Protocol. Rest, ice, compression, and elevation are part of a protocol we often implement for our patients. Resting involves avoiding the activity that caused the pain while the stress fracture heals. Icing decreases inflammation and swelling in the affected area. Lastly, compression and elevation help reduce pain and swelling.

• Non-steroidal anti-inflammatory drugs (NSAIDs) can decrease the inflammation and pain caused by the stress fracture. If the pain is more severe, you may be recommended prescription-strength NSAIDs. 

• Protective footwear like a CAM boot or surgical shoe can be worn to reduce the stress on the affected area while walking or standing. 

• In severe cases, casting can be performed to offload and stabilize the area thoroughly. However, this is a less common treatment method and is typically used only when multiple stress fractures occur. 

Temporarily refraining from high-impact activities is key to recovery from a stress fracture in the foot or ankle. Returning to sports or physical activities too quickly not only delays the healing process but also increases the risks of a complete breakage. 

Recovery Time for Stress Fractures 

Being evaluated and beginning your stress fracture treatment early generally leads to a faster recovery. Conversely, allowing too much time to pass can cause the stress fracture to worsen and even turn into a more extensive breakage. In this case, recovery can take up to eight weeks. Surgery may also be required if the bone becomes displaced or shifts out of its natural alignment. 

Returning to Physical Activities After a Stress Fracture

How quickly you can return to your physical activity largely depends on the severity of the condition and how quickly you stopped when the pain started. A stress fracture can take 6-8 weeks on average to heal, but you might have to avoid high-impact activities for a few more weeks. 

To achieve the best results and avoid reinjury, it’s best to follow your foot and ankle specialist’s recommendations. 

Pointers for Preventing Stress Fractures

Here are some pointers worth following to avoid stress fractures: 

• Set incremental goals when starting a new sport. For example, when training for a 5k run, gradually build up your mileage weekly to prevent injuries. 
• Use proper footwear for your activity. 
• Maintain a healthy diet consisting of calcium and vitamin-D-rich foods in your meals. 
• If pain or swelling begins while exercising or training, immediately stop the activity and rest for a few days. 

Don’t Let Foot Pain Keep You From Enjoying Life

Stress fractures may not seem as serious as other injuries, but they still cause pain that can interrupt your activities. It’s crucial that you get checked out by a foot and ankle specialist as soon as possible. Prompt and personalized treatment can help you recover quickly and return to your routine with confidence.