Stress Fractures

Stress fractures of the foot can develop suddenly and can put a screeching halt to your training regiment. They are one of the most common injuries to runners and other athletes who put a lot of pressure on their feet with their activities. The injury normally happens as a result of overuse.

The stress fracture is a small crack in a bone, usually in a weight-bearing bone. There are several areas of the body where these commonly occur. One is the navicular, which is a bone on the very top of the foot. Another is the calcaneous, or heel, of the foot.  The metatarsals, or long bones, of the foot are susceptible, especially the second and third metatarsals. The fibula in the lower leg is another common stress fracture location.

Symptoms of a stress fracture include swelling in the area, which can become very tender to the touch. It is common for the pain to flare up only during periods of activity, subsiding afterwards. This will be a recurring pattern associated with a stress fracture. It is important to stop running (or the troublesome activity) if a stress fracture is suspected. Repeated overuse can cause even more damage, including a complete break of the bone.

Stress fractures usually occur when the surrounding muscles are tiring and are not providing the level of support that they normally do. This will allow more of the pounding of the activity to be transferred directly to the bone instead of being absorbed by the muscles. This often happens when people are under conditioned and not ready to attempt the level of activity that they are attempting. Doing too much too soon is quite characteristic of a stress fracture event. This is not always just when someone is beginning an exercise program, but often when an increase in training intensity, frequency, or duration occurs. Additionally, poor equipment such as worn-out running shoes can greatly increase the risk of a stress fracture.

Initial treatment of a stress fracture should include icing for short periods (less than 20 minutes) several times daily.  Acetaminophens (pain relieivers) such as Tyleonol can be used effectively. Ibuprofens (such as Advil) should be avoided as they do not aid bone healing. Short periods of exercise should be initiated, but if the pain flairs up again it is advisable to consult with a physician.

flexcast stress fracture

Foot stress fracture


Physicians may often miss a stress fracture on a x-ray since they are usually very small. Podiatrists are trained to look for them in the typical areas where they often occur. If a stress fracture is diagnosed, the podiatrist may recommend some form of walking boot or crutches to eliminate stresses on the area and allow it to heal. A cast may be recommended, especially for the navicular or the fifth metatarsul. Surgical procedures are sometimes required to insert pins or a plate to ensure that the small foot bones remain in place during the healing process.

Resting is critical, and a 6 to 12 week recovery time should be expected. Other forms of exercise are encouraged, such as swimming, stationary bikes, and upper body workouts. Quicker healing can be expected if the feet are rested as much as possible.

After the injury has healed sufficiently, it is important to ramp up slowly back to your pre-injury level of activity. About 60% of all stress fractures occur in people who have already experienced one. In other words, you are more susceptible to having a re-injury. The importance of good footwear, and of training within limits, are key components to ensure that a repeat injury does not happen.


Image courtesy Flickr/Kevin Teague