Stress fractures are tiny cracks in a bone caused by repetitive force, often from overuse, such as repeatedly jumping up and down or running long distances. Stress fractures in the foot and ankle are common among athletes, especially runners.

Common Symptoms

• Pain: Gradual onset of pain that worsens with weight-bearing activities and improves with rest.
• Swelling: Swelling around the affected area, which may or may not be accompanied by bruising.
• Tenderness: Pain when touching the affected bone.
• Changes in Gait: Limping or changes in walking pattern to avoid pain.

Cause & Anatomy

• Overuse: Repetitive activities that place stress on the bones, such as running, jumping, or dancing.
• Sudden Increase in Activity: Rapidly increasing the intensity, duration, or frequency of physical activity.
• Improper Footwear: Wearing shoes that do not provide adequate support or cushioning.
• Weak Bones: Conditions such as osteoporosis or insufficient calcium and vitamin D intake can weaken bones.
• Biomechanical Factors: Abnormal foot structure, such as flat feet or high arches, can increase the risk.

Diagnosis

• Medical History and Physical Examination: Assessment of symptoms and examination of the foot and ankle for pain and swelling.
• X-rays: May not show early stress fractures; repeated after a few weeks if symptoms persist.
• MRI: Highly sensitive and can detect stress fractures early.
• Bone Scan: Used if MRI is not available or not suitable; shows increased bone activity at the fracture site.

Prevention

Gradual Increase in Activity:

• Increase the intensity and duration of physical activities gradually to avoid overloading the bones.

Proper Footwear:

• Wear shoes that provide adequate support and cushioning for your specific activity.

Cross-Training:

• Incorporate low-impact activities, such as swimming or cycling, to reduce stress on the bones.

Bone Health:

• Ensure adequate intake of calcium and vitamin D to maintain strong bones.

Address Biomechanical Issues:

• Use orthotics or insoles to correct abnormal foot mechanics if necessary.

Non-Surgical Treatment

Rest:

• Avoid weight-bearing activities to allow the bone to heal. Use crutches if necessary.

Ice:

• Apply ice packs to the affected area for 15-20 minutes several times a day to reduce pain and swelling.

Elevation:

• Keep the foot elevated to help reduce swelling.

Protective Footwear:

• Wear stiff-soled shoes, a walking boot, or a brace to protect the foot and limit movement.

Medications:

• Over-the-counter pain relievers, such as acetaminophen or NSAIDs, to manage pain and inflammation.

Physical Therapy:

• Rehabilitation exercises to restore strength, flexibility, and balance once the bone begins to heal.

Surgery

Rarely required but may be necessary if the stress fracture does not heal with conservative treatment. Surgery involves placing screws or pins to stabilize the bone.

Rehabilitation

Gradual Return to Activity:

• Slowly resume normal activities and sports under the guidance of a healthcare provider to prevent re-injury.

Strengthening Exercises:

• Engage in exercises to strengthen the muscles around the foot and ankle, improve balance, and reduce the risk of future stress fractures.

FAQ’s

How long does it take for a stress fracture to heal?
Most stress fractures take 6-8 weeks to heal with proper rest and treatment. Severe cases may take longer.

Can I continue to exercise with a stress fracture?
Weight-bearing activities should be avoided until the fracture heals. Non-weight-bearing exercises, such as swimming, may be allowed with your healthcare provider’s approval.

What happens if a stress fracture is left untreated?
Untreated stress fractures can lead to a complete break, delayed healing, chronic pain, and complications that may require surgery.

Are there long-term effects of stress fractures?
With proper treatment and rehabilitation, most stress fractures heal without long-term effects. However, repeated stress fractures or improper healing can lead to chronic issues.

How can I tell the difference between a stress fracture and a sprain?
Stress fractures typically cause localized pain that worsens with activity and improves with rest. Sprains usually involve more widespread pain, swelling, and bruising and result from a specific injury.