Stress Fractures of the Foot: Symptoms, Prevention, and Treatment
Diving wholeheartedly into a fitness regime is admirable, but doing so without adequate preparation can lead to negative health outcomes, like stress fractures in the bones of the feet.
While common, many are still in the dark about the best course of treatment for this type of injury, as well as what can be done to prevent it happening in the first place.
Here are the common causes of stress fractures, the telltale signs that one has occurred, and the treatments that can help sufferers get back on their feet.
What Are Stress Fractures?
Stress fractures are tiny cracks in bones. Unlike acute fractures, which occur after a traumatic one-time injury, they develop gradually from overuse and repetitive force. The feet are especially susceptible because they are frequently under some degree of pressure, force, or weight.
Bones, including those of the feet, are in a constant state of degradation and regeneration, a process known medically as bone remodelling. This is influenced by a number of factors, including diet, biomechanics, and physical exertion. If such factors cause the breakdown of older bone faster than new bone can be created, the bone weakens, and becomes vulnerable to fracture (1).
What Causes Foot Stress Fractures?
Sudden Increases in Activity
Sudden bouts of rigorous physical activity can result in a number of ailments, including plantar fasciitis, achilles tendon pain, and stress fractures. Those who were previously sedentary, or who rapidly increase the intensity, frequency, or duration of training sessions are at particular risk (2,3).
Change in Training Surfaces
Whether the individual usually exercises on sand, grass, road, or a treadmill, a switch in training surfaces places novel demands on the structure of the foot, potentially forming a stress fracture (4).
Poor walking form, blisters, or bunions may influence the way a person’s feet strike the ground, placing undue pressure on the bones.
Other Existing Foot Problems
Those with particularly flat feet, high foot arches, or previous stress fractures are more likely to develop the condition.
Footwear that’s improperly fitted, or fails to provide adequate cushioning, control, or flexibility for the given application increases the risk of a foot stress fracture.
Low levels of vitamin D and calcium decrease bone density and strength over time, making them more prone to injury. Not generally eating enough for the demands of your sport can also lead to problems known as Relative Energy Deficiency in sport (RED-S) which predisposes to stress fracture (5).
What Are The Symptoms of Foot Stress Fractures?
Tenderness, Dull Pain, or Stabbing Pain
Stress fractures can, understandably, be a significant source of discomfort. People with this injury may experience pain or soreness when the affected area is touched or when it bears weight. A consistent ache deep within the foot or toes may also be present, though the pain tends to subside when at rest.
Performance during sport or day-to-day activities is likely to diminish when the structure of the foot is compromised by a fracture.
Swelling may appear over the fracture site. This is particularly noticeable on the top of the foot.
Changes in Biomechanics
Sufferers may change their cadence, stride, gait, or stance in order to put less pressure on the foot. This can lead to developing inefficient and harmful movement patterns.
Though infrequent, blue, red, or purple bruising of the skin can be observed in untreated stress fractures.
How Can You Prevent Foot Stress Fractures?
Ramp Up Your Training Slowly
The old adage “slow and steady wins the race” remains a classic for good reason. Easing into your fitness regime helps mitigate the chance of not only developing a stress fracture, but also a raft of other lower limb injuries.
To avoid overexerting the structures of the foot and ankle, it’s recommended that you only increase the amount you train by 10% a week (6). This measured approach, often referred to as ‘gradual loading’, helps your body build up the strength needed to tackle longer intervals, and adjust to new surfaces or movements (7).
It’s also important to warm up appropriately before exercising, and seek medical attention should lasting or acute pain occur.
Choose Appropriate Footwear
The right shoes can encourage the wearer to strike the ground with their midfoot or forefoot rather than their heel. This distributes shock more evenly throughout the feet and body, minimising the chances of sustaining a stress fracture (8).
Depending on the needs of the individual, increased arch and ankle support may be called for (9).
Undertake Low-Impact Activities
As well as being a great way to maintain overall fitness, cross-training with low-impact activities helps you avoid repeatedly stressing the same part of the body.
Swimming and weight lifting, including seated resistance training, should be used as a complement to higher-risk activities like running, dancing, and basketball.
Maintain Proper Nutrition
The benefits of maintaining proper nutrition are vast. Ensure your calcium and vitamin D levels are adequate to minimise the risk of bone fracture or breakage.
What Treatments are Available for Foot Stress Fractures?
To stem the associated pain and inflammation, ice, acupuncture, deload taping, and massage may be administered. Such interventions are non-invasive or minimally-invasive, and have been shown to provide significant relief from swelling and discomfort.
If the individual can walk without excessive pain, further treatment is often centred around rest, stretching and strengthening of the surrounding muscles, and avoiding activities likely to worsen the injury. In more severe cases, the specialist may recommend temporary immobilisation of the foot and ankle through the use of a weight-bearing boot.
In either case, focused shockwave therapy may be performed as an adjunct to other modes of physiotherapy. The procedure involves directing acoustic waves into damaged tissue via handheld device – an act that encourages both rapid healing and enhanced pain management. A 2015 International Journal of Surgery article stated that when used to treat stress fractures, focused shockwave therapy was associated with a “… high rate of recovery, return to competition and pain control” (11).
In order to prevent re-injury, continued rehabilitation and progressive strengthening are of utmost importance. The physiotherapist will be able to develop a tailored program to enable the patient to resume day-to-day activities, exercise, and sport safely.
Using pins, screws, or metal plates, surgeons are able to repair high-risk or highly severe stress fractures. This option is a last resort, and should only be considered when all other treatments have been exhausted (12).
What Should You Do If You Experience a Foot Stress Fracture?
If you experience recurring pain in the feet, it’s important to consult with a qualified health professional. An accurate diagnosis is vital to get you on the correct management plan. Reliable and experienced physiotherapists, like those at E3 Physio, will be able to pinpoint the source of your discomfort, as well as administer proven and effective therapies.
At E3, we help patients manage foot stress fractures through a combination of pain relief and active treatments such as stretching and strengthening exercises. Additionally in some cases we find focused shockwave therapy can be a helpful addition to our care. This multifaceted approach has allowed countless clients to overcome foot pain and safely return to doing the things they love.