Stress Fractures of the Foot and Ankle

Type of Foot and Ankle Stress Fractures

The human foot contains 26 bones, many of which are small and vulnerable to stress fractures. The bones that are most often affected include:

• Metatarsals. Long, thin bones that connect each of the toes to the foot. When a stress fracture occurs at the base of the fifth metatarsal (pinky toe) it is called a Jones fracture.
• Calcaneus. More commonly known as the heel bone.
• Navicular. A small, wedge-shaped bone on the inside of the middle foot that helps form the arch.
• Talus. A small bone in the hind-foot that connects with the shin and calf bones to form the ankle joint.
• Sesamoids. Small, bony nodules embedded within the tendons of the big toe.

The most common symptom of a foot or ankle stress fracture is pain that develops gradually and worsens during weight-bearing activity. Additional symptoms may include swelling, tenderness and bruising.

Risk Factors & Causes of Stress Fractures

Most stress fractures, particularly those in the foot or ankle, are overuse injuries. These occur when a weight-bearing movement is repeated frequently with inadequate rest between sessions, resulting in microscopic damage to the bone. Over time, the weakened bone can develop a crack or stress fracture.

Additional risk factors include:

• Changing or suddenly increasing the frequency or intensity of exercise.
• Foot conditions that alter your weight-bearing mechanics such as bunions or tendonitis.
• Decreased bone strength and density due to osteoporosis, Vitamin D deficiency or certain long-term medications.
• Wearing poorly fitted shoes that do not provide adequate shock-absorption or arch support.

Diagnosis and Treatment of Stress Fractures

Doctors can typically diagnose a stress fracture in the foot with a simple physical exam. The pain reported in response to gentle pressure will usually be limited to the area directly over the injury and not generalized to the whole foot. In some cases, imaging tests like X-ray may be used to confirm the extent and location of the fracture.

Many stress fractures will heal on their own over time with the RICE protocol:

Rest: Avoid high impact, weight-bearing activities.
Ice: Apply cold packs immediately after injury and several times a day to minimize swelling.
Compression: Lightly wrap the area in a soft bandage to help prevent additional swelling.
Elevation: Keep the injured foot elevated above the level of the heart as much as possible.

Your doctor may also recommend one or more of the following:

• Walking boot or brace
• Crutches
• Casting (rarely)
• Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen

Although rare, some stress fractures may require surgery to heal properly. Most often, this is necessary when patients do not rest appropriately after a stress fracture, causing the fracture to worsen or break completely.

Returning to Activity after a Stress Fracture

Most stress fractures will require at least 6 – 8 weeks to fully heal. Once cleared to do so, normal activities should be resumed very gradually, ideally alternating days of activity with days of rest. Doing too much, too soon can lead to re-injury that may require surgery.