Stress Fracture Foot Problems

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

When treated correctly stress fractures usually heal quickly, but if they are left untreated they can become a serious problem, leading to chronic pain and stiffness.

How Do Foot Stress Fractures Occur?

Foot stress fractures develop when the foot is repeatedly over-loaded placing too much force through the foot bones.  It is typically the repetitive action of the foot striking the floor that leads to foot stress fractures with activities such as football, tennis, gymnastics and basketball.  Runners are also commonly affected. 

What Causes Foot Stress Fractures?

As we have already seen, stress fracture foot problems typically affect athletes, particularly if the have recently increased training levels or taken up a new sport. There are also other factors that increase the risk of stress fractures foot problems:

• Gender: foot stress fractures more commonly affect women.  This is thought to be due to reduced oestrogen levels which can weaken the bones, especially in those with an irregular menstrual cycle
  
  
• Age:  Adolescents are often affected by foot stress fracture problems as their bones are still growing and therefore aren’t as strong

• Changing Training Surface: Suddenly switching the surface you regularly train on e.g. from grass to concrete can increase the risk of stress fracture foot problems occurring
  
  
• Osteoporosis: This reduces bone strength and density increasing the risk of fracture

Where Do Stress Fractures Occur?

Stress Fracture Foot Symptoms

The most common symptoms of a stress fracture of the foot are:

• Pain: A stress fracture foot problem usually starts off with mild pain and gradually gets worse.  The pain tends to come on during exercise and eases off with rest.  As things progress, pain tends to come on quicker and lasts longer until it affects everyday activities like walking and standing to the point where there is little respite from the pain
  
  
• Swelling: There may be some swelling around the area of the fracture which gets worse with activity and improves with rest. In some cases there may be a hard lump on top of foot
  
  
• Tenderness: It might be tender to touch the area of the stress fracture

How Do You Detect A Stress Fracture?

Treatment For Foot Stress Fractures

The goal of treatment for stress fracture foot problems is to reduce the pain and inflammation and allow the bone to fully heal so you can return to activity.  Treatment for foot stress fractures usually consists of:

• Rest: The most important thing to do if you are suffering from stress fracture foot problems is to rest.  Failure to do so can lead to a more complex fracture (break) of the bone.  Stop the activity that caused the pain to start in the first place, typically for 6-8 weeks to allow the fracture to heal.  You can continue exercising, as long as you aren’t placing excess pressure through the foot – try activities like swimming and cycling.

• Braces: You may be advised to wear a special walking shoe or brace to reduce the force going through the foot.  In severe cases, you may need a splint or cast.

• Crutches: Crutches may be advised to help you keep your weight off the affected foot for a couple of weeks.  Usually after this you can start weight bearing again as this actually helps stimulate healing.
  
  
• Medication: Your doctor may prescribe drugs like Paracetamol or Tylenol (acetaminophen) to help relieve pain.  These tend to be more appropriate than drugs such as ibuprofen (e.g. Advil or Neurofen) or naproxen as there has been some research suggesting that these can actually delay bone healing.

• Surgery: Stress fracture foot problems rarely require surgery but if the fracture fails to heal, surgery may be indicated.

Returning To Activities

It is important not to return to your usual activities too quickly following stress fracture foot problems otherwise the fracture may not heal properly and you’ll be back to square one.  Avoid the activity that caused the injury for approximately 6-8 weeks or longer if necessary until you are completely pain-free. 

Pace yourself when you return to activity.  Start slowly and gradually increase the intensity, duration and frequency.  Ideally, start with non-weight bearing activities such as swimming and cycling before starting high-impact activities.  If the pain returns, stop immediately. 

How To Prevent Stress Fractures

As always, prevention is better than cure. Stress fracture foot problems frequently recur with approximately sixty percent of stress fractures sufferers having had a previous fracture. 

Here are some top tips on how to reduce the risk of suffering from a stress fracture in your foot:

• Exercise Progression: when starting new activities or when you want to up training schedules, do so slowly.  Follow the 10% rule – do not increase the intensity or duration of exercise by more than 10% per week.  This allows your body to adapt to the increased expectations on it.  Make sure you warm up and stretch before exercise and take regular breaks
  
  
• Footwear: Make sure you are wearing comfortable, supportive footwear that fits properly.  If you have abnormal foot biomechanics such as high or fallen arches, talk to your doctor about whether you would benefit from foot orthotic insoles
  
  
• Vary Exercise: Vary the type of exercise that you do to help avoid repetitive stresses on the same part of your feet
  
  
• Diet: Ensure you are getting plenty of Calcium and Vitamin D in your diet to help keep your bones strong
  
  
• Exercises: Strengthening the muscles around the foot and ankle can help reduce muscle fatigue and improve bone density reducing the risk of stress fracture foot problems. Visit the foot and ankle exercises section to find out more

What Else Can Help?

Stress fracture foot problems are just one cause of pain on the top of the foot.  If this is not sounding quite like your problem, visit the top of foot pain section or the foot pain diagnosis section for help working out what is wrong.

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Page Last Updated: 14/10/20
Next Review Due: 14/10/22