Stress Fracture

A painful fracture in a bone of the foot

A High Impact Overuse Injury

Frequently seen in athletes, a stress fracture is a small but painful break in high impact areas of the foot. The break is caused by repetitive stress on the bone with the result being a small crack in the bone. If it is not treated properly the bone may fracture all the way through.

What are Stress Fractures?

A stress fracture is a small but painful fracture in a bone of the foot, most commonly seen in athletes.

A stress fracture is similar to a bone bruise, and typically occurs after some type of trauma or overuse.

There are four main types of stress fractures and they can occur in different areas of the foot. The most common type is a metatarsal stress fracture, which usually occurs in the 2nd metatarsal in the forefoot. In addition to the metatarsal bones, stress fractures can also occur in the sesamoid bones, navicular bone, or the calcaneus (heel bone). The pain is usually a sudden onset and it is usually difficult to pinpoint the exact moment of injury.

What are the Symptoms of Stress Fractures?

Symptoms of a stress fracture include:

  • Pain/swelling at the site of the fracture
  • Tenderness and pain when touched on a bone
  • Pain that begins after starting an activity, and subsides with prolonged rest
  • Pain which is worse on one side, such as jumping to one leg or shifting weight

If left untreated, the pain from a stress fracture can become quite severe. There is also a risk that the fracture can become displaced, meaning the fractured bone is out of alignment. Depending on the area a stress fracture is, certain stress fractures can be more high risk than others.

What Causes Stress Fractures?

Often a stress fracture is caused by repetitive force or stress on a particular bone of the foot.

It is often seen in runners and others who participate in athletic activities that include running and jumping. It frequently develops for people who suddenly increase physical activity, such as army recruits or students who begin a new school sport. It can also be caused by a biomechanical issue in the gait cycle in which the foot does not offload pressure at the proper time.

Primary causes include:

  • Poor technique in sports/training
  • Too rapid of an increase in volume when training
  • Changing the surface you are training on (grass to concrete for example)
  • Running on an incline
  • Exercising with improper footwear
  • Specializing in a sport at too young an age (for example, youths playing a sport year round)

There are other contributing factors as well such as:

  • Age: Older athletes may have lower bone density which can elevate the risk of getting a stress fracture.
  • Weight: Both ends of the spectrum can be at risk. Someone who is underweight may have weakened bones, and someone more overweight may be putting more stress on their bones.
  • Foot problems: Issues such as blisters, bunions, tendonitis, or low/high arches can put undue stress on your body and put you at a higher risk of getting a stress fracture.
  • Medical conditions: Osteoporosis and other diseases that weaken your bones can elevate the risk of getting a stress fracture.

How can I treat stress fractures?

If you believe you may have a stress fracture you should see a doctor for a diagnosis and a treatment plan.

This is important because if you continue without treatment the condition can worsen. You will need to avoid the activity that caused the stress fracture while the injury heals and avoid pressure on the foot. The doctor may have you wear a boot or another type of device to keep pressure off the area of the fracture. Your treatment plan will most likely include rest and at one point some type of orthoses for the foot. A shoe with a stiff rocker bottom will help to aid in the healing process.

It is always important to pay attention to your footwear, especially if you are participating in high impact sports.

Some popular shoe companies make athletic shoes with very soft cushioning which can eventually lead to foot problems and injuries. Usually the best shoes for sports and other activities will have a firm foundation, and possibly a firm cushion – in other words, you may want to stay away from those bendy twisty shoes! Many athletes also benefit from an insole or orthotic to help properly control the motion of the foot during sports.

How to prevent stress fractures

Fortunately stress fractures are fairly easy to avoid, they just require a few simple steps to follow.

Be gradual with new exercise routines

When switching up exercise routines, or getting back to the gym after a period of time off it’s important to ease into the exercise a bit rather than rush into a lot of new exercise all at once.

Use proper footwear

Make sure your shoes fit well, and are appropriate for your activity. Using insoles for extra support in your shoes can also be beneficial. Unsure of where to start? Check out our insole advisor to get set up with the right insoles for you.

Mix things up with your workouts

Add low-impact activities to your workout routine to mix things up. This type of cross training will help your general fitness and keep your body healthy. It can also help prevent stress fractures that come with repeated motions.

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