Stress Fractures of the Feet

Stress fractures of the footThere are 26 bones in the feet which take a pounding with every step. Repeated impacts like that can result in tiny hairline or stress fractures of the feet. There are certain bones in the feet which are more likely to sustain stress fractures in runners as they recieve most of the impact. These tend to be the Metatarsals (long bones between the mid foot and toes), with the second and thirid metatarsals being the most often affected. The calcaneus, or heel bone, can sometimes sustain a stress fracture.

What are the symptoms?

The most common symptoms of stress fractures of the feet, regardless of its location are an aching pain which develops whilst running and eases with rest. As the condition progresses, the pain begins earlier in the run and becomes sharper. If treatment and rest are not sought then the pain will also be present at rest. There is usually an acutely tender spot on the bone if you can find it to press! There may also be some mild swelling or ‘puffiness’. Those with a metatarsal stress fracture will feel this pain in the middle of the foot. Those with a calcaneal stress fracture will feel it around the heel.

Causes

As already covered, stress fractures of the feet occur due to repeated impacts. But why do some people get them and other s don’t? Well there are a few factors which can lead to an increased risk of developing stress fractures in the feet. These include:

  • A rapid increase in running frequency or duration.
  • Biomechanical flaws especially oversupination.
  • Transitioning to barefoot or minimalist running shoes.
  • Decreases in bone density.
  • Worn out or inappropriate running shoes.

All of these things (with the exception of bone density issues) increase the stress on the bones of the foot. By far the most common of these causes are the first two. Sudden increases in training are easily avoided and so this shouldn’t be a problem for the experienced runner. Biomechanical problems are less easily avoided but can be corrected with suitable running shoes, additional support and improvement of movement patterns with rehabilitation exercises.

Treating Stress Fractures of the Feet in Runners

If you suspect you have a stress fracture, rest from running immediately, prevent unnecessary weight bearing and walking and seek medical attention.

A Doctor may refer you for an x-ray, but bear in mind that stress fractures often do not appear on x-rays until about 2 weeks after they develop. If the x-ray is clear you may be referred for a bone scan if you’re lucky!

Once a stress fracture is confirmed the main form of treatment is rest. As with standard fractures, they will heal on their own and there isn’t too much you can do to speed the healing up. Your Doctor may get you to wear a walking boot for a couple of weeks or use crutches to take some of the weight off it to allow it to heal.

Generally, time away from running for a stress fracture is around 6 weeks. The fracture will heal within this time and you can then start a very gradual return to running. In the meantime, other forms of exercise which are less weight bearing and impact based can be performed. Great examples are swimming and cycling.

Also use this time to figure out why the stress fracture occurred. If it’s a sudden increase in training then that’s an easy fix! If not, get a gait analysis done at a specialist running shop or podiatrists. This can help you determine if your footwear is suitable, if you need new shoes and possibly if you have other biomechanical problems or muscle imbalances from higher up the chain.

Women of menopausal age and older might want to discuss bone density with their GP if all other possible causes have been ruled out.

Once the fracture has healed and there is no pain on a daily basis, a return to running can begin. It is adviseable to start on a treadmill if possible as the surface is more forgiving and so places less impact on the bones. If this is not an option, try your first few runs on grass or sand.

Start with a 5 minute run. I know it sounds like nothing, but better to be safe than sorry! Then have 2 days rest before trying another 5 minutes. If all is well, next week try two-three 10 minute runs. Continue to increase in 5 minute increments, back up to your usual running program.

2 thoughts on “Stress Fractures of the Feet

  1. simon

    I had a calcaneal RSI fracture confirmed on MRI (presumed no cortical involvement); used a crutch for partial weight bearing for 3 weeks; pain resolved so I am now doing daily activities with no aid – making sure I avoid any heavy lifting and conscious of forces applied to the injure heel.. Started back at the gym in the fourth week for upper body exercises only. Heel remains pain free on finger palpation and “spueeze” test. Interested in people’s opinion as to how to progress from here. eg. is there logic to spending some time in a Cam boot?

    Reply
    1. Heidi Dawson Post author

      Hi. If you have no pain whatsoever and it has been a minimum of 6 weeks since injury then you are ready to start gradually getting back into exercise. I would start with a few walks, getting longer in distance, maybe 2-3 times a week for a couple of weeks. Then, presuming there are still no problems, you can start a run/walk program. Also make sure that any potential causes of your stress fracture have been corrected. It may have just been a too sudden increase in mileage which is the easiest problem to fix! Also new running shoes might be a good idea.

      Reply

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