Identifying, Preventing, and Treating Stress Fractures in the Feet

What is a stress fracture?

A stress fracture, also called a hairline fracture, fissure fracture, or march fracture is a tiny crack in one of the metatarsal or navicular, weight-bearing bones of the foot. It’s usually not the result of falls or other accidents, but most often happens when you rapidly increase your activity level, or the amount of time spent on your feet.

What can put you at risk for a stress fracture?

Usually, your bones adapt to changes in pressure or activity gradually in a process called remodeling. Remodeling causes some bone tissue to be destroyed and rebuilt to accommodate the new activity. It is part of the change your body undergoes when you begin a new fitness routine, for instance.

When change happens too rapidly, it can cause bone tissues to be destroyed faster than your body is able to replace them, leaving your bones very fragile. When your bones are fragile, they are at a high risk of a stress fracture.

Although a crack caused by a stress fracture is tiny, ignoring it can cause the fracture to become much worse. This, in turn, could lead to a full break of the affected bone, most typically the metatarsals, which are the long bones that run from the midfoot to the toes.

Fifth metatarsal stress fracture info-graphic

What are the symptoms of a stress fracture and what should you do if you suspect you have one?

If you have any symptoms of a stress fracture, such as a swollen or bruised foot, a tender foot, foot pain that feels worse when you walk, run, or stand for an extended period of time, or pain that eases at night or when you rest, contact a medical professional to discuss what treatment would be best for you.

Certain factors can increase the risk for a stress fracture, such as sports that require repeated jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that's weakened by a condition such as:

  • having osteoporosis or other conditions that cause weakened bones
  • sustaining a previous stress fracture
  • playing high impact sports, such as tennis or basketball
  • being involved in gymnastics or dance
  • having high or rigid arches
  • having flat feet
  • moving from a sedentary lifestyle to an active one very suddenly
  • making any major shift in activity level
  • having an irregular menstrual cycle
  • having an eating disorder
  • consuming a diet lacking in vitamin D and calcium
  • frequently wearing ill-fitting, non-supportive, or worn-out shoes

What role do shoes play in this fragile situation?

Our feet carry our entire body weight all day long and are made up of not only bones and muscles, but ligaments and tendons, too. It’s important to keep your feet healthy by wearing proper fitting shoes for the different purposes in your life, such as work, dress, and sports activities.

Are athletes at higher risk?

If you were an athlete, it's important to keep in mind that there are factors ranging from how you train to your diet that can make you more at-risk for stress fractures. These factors can include:

  • Practicing incorrect training or sport technique
  • Having too rapid of a training program or volume of activity or changing your activity level without a gradual break-in period
  • Changing the surface on which you exercise, such as going from a soft surface (like an indoor track) to outside on gravel or concrete.
  • Running on a track or road with a sloped surface
  • Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff)
  • Having a poor diet that has inadequate caloric intake for volume of sport
  • Having a low vitamin D level
  • Experiencing early specialization in sports. Youth who play one sport year-round without a break are at risk of stress fractures.

Are there any other common factors that can put a person at a higher risk?

Age: Older athletes may have underlying bone density issues. Already weakened bone will develop a stress fracture sooner than healthy bone.

Weight: Both ends of the spectrum are at risk for stress fractures. An underweight individual may have weakened bones and some overweight individuals doing repetitive exercises would also be at risk for injuries.

Anatomy: Foot problems can affect the way the foot strikes the ground, such as having bunions, blisters, tendonitis, and low or high arches. Muscle weakness, imbalances or lack of flexibility.

Sex: Females may be at risk if they have irregular menstrual periods or no periods.

Medical conditions: Osteoporosis or other diseases that weaken bone strength and density (thickness) may not be able to handle changes in activity.

What is the treatment plan for a stress fracture of the foot?

The approach for treatment greatlt depends on the severity of the fracture. The most common treatments include:

Rest: A doctor will typically advise you to avoid putting weight on your foot for 6 to 8 weeks while your stress fracture heals. Your doctor may give you a list of safe activities you can do during this time.

Ice: Ice can help reduce swelling in your foot and relieve pain.

Elevation: Elevating your foot at night and while sitting may minimize swelling and help drain excess fluid.

Pain medication: To help manage pain, your doctor may recommend over-the-counter non-steroidal, anti-inflammatory drugs (NSAIDs). If your pain is more severe, your doctor may write you a prescription for a stronger medication.

Casting: Not all stress fractures of the foot require a cast, but some do. Casting can help keep your foot stable while the bone heals.

Protective footwear: Protective footwear such as a boot or brace can reduce stress on your foot when you do need to stand or walk. Or, using crutches to avoid weight on the injured foot can help promote healing.

Surgery: Most stress fractures heal without surgery unless surgery is needed to ensure proper healing, especially in those that occur in areas with a poor blood supply. Typically, this involves placing medical screws or plates into the bone in your foot to hold it together. Surgery is also an option for elite athletes who want to return to their sport more quickly or others who work in a field that necessitates constant use of the stress fracture site.

Once the stress fracture has healed (usually 4-8 weeks), it is important to gradually increase physical activity and wear proper footwear to prevent further injuries. In some cases, a healthcare provider may recommend physical therapy or custom orthotics to address underlying biomechanical issues that may have contributed to the stress fracture.

For more information on other foot pain issues and treatments available click here for an in-depth guide to identifying foot pain.

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