Managing a Foot Stress Fracture the Right Way

Stress fractures in the foot are usually characterized as an overuse injury of weight-bearing bones.  High impact sports involving running and jumping such as distance running, basketball, tennis, and football are where most athletes with foot pain are found.

Bones generally respond to stress by hardening along the outer margins of those bones.  When bones are suddenly exposed to great forces or repetitively exposed to increasing stress, there is insufficient time for those bones to adapt.  Meanwhile, when the muscles associated with the feet become fatigued, they lose their shock absorbing capacities. These uncontrolled forces are inadvertently transferred to the nearby bones and can result in small cracks in the bones, better known as “stress fractures”.

Foot pain from stress fractures is typically perceived in on top of the foot. However, pain in the feet can be demonstrated along your heels, sides of the feet and within the ankle joint itself.  A common location for stress fractures is along the outer ridge of the forefoot over the 5th metatarsal bone, as noted in the photo above.  This is often called either a Jones Fracture or a Dancer’s Fracture, depending upon the location of that metatarsal fracture.

Individuals with a stress fracture usually experience an increase in the pain with movement and, as the condition worsens, even with rest. 

Source of Sore Feet

Overuse events including repetitive loading of the lower extremity with high impact activities such as running, soccer, football, basketball, gymnastics,…etc. are the basic causes of stress fractures.

Footwear with little or no shock absorbing capacities is another predisposing factor to stress fractures. Statistically, more cases are recorded in women, probably because of poor nutrition, eating disorders, and infrequent menstrual cycles. Excess aerobics drills in a short time with insufficient rest will increase the chances of getting a stress fracture.

Obviously any underlying bone diseases or disorder will drastically increase the risk got a painful foot.

Signs & Symptoms of Stress Fractures in the Foot

  • Localized pain on any bone of the foot, especially during running.  The pain can be dull aching or sharp, occur during activity, and may persist with rest.
  • Mild to severe swelling and point-tenderness in the foot.
  • The pain may worsen with prolonged exposure to ice and during sleep.
  • An initial sensation of sharp pain followed by intensifying aching is common. 
  • Localized discoloration and surrounding joint stiffness is possible.

Professional Treatment for Stress Fractures

  • Rest and Ice.
  • Consult a physician early for an exam, x-rays and special testing if necessary.
  • Avoid excessive weight-bearing on the affected foot.
  • Wear shock-absorbing footwear and if symptoms worsen, a walking boot is a great tool to help control the stress on the injury site.   
  • A non-weight bearing cast and crutches if necessary.
  • Eat healthy and ingest Recommended Daily Allowance (RDA) amounts of calcium and vitamin D to help restore bone integrity.
  • Strength training to the arch, toe flexors and weak muscles of the lower extremity when the symptoms improve.
  • Maintain range of motion of the surrounding muscles and joints.  This especially relates to the Achilles, calf, plantar fascia, great toe and ankle joint.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What would you consider to be the main reasons why this injury occurred?
  2. Do I need further diagnostic tests to assess this injury?
  3. How can I best manage this pain and to be able to get back to my sport?
  4. What are my treatment options outside surgery?
  5. Do I have any leg length discrepancies or biomechanical abnormalities that need to be corrected with orthotics or treatment to avoid any long-term issues with this pain in my foot?

Elite Sports Medicine Tips from Mike Ryan

  • Reporting Time –  See a sports medicine specialist as soon as symptoms appear to manage this foot pain quickly.
  • Rest Rocks –  It’s the boring option but REST is the #1 tool to quiet down a stress fracture.  For how long?  It may be 2 to 6 weeks if the symptoms persist. 
  • Return to Play – Resume your pre-injury activities slowly. Regular strengthening and stretching exercises should be included in your routines.
  • Cross Train –  Cross Training is King. Adding biking, swimming, yoga, Elliptical trainer,…etc. are great ways to stay in shape and save your marriage during this “downtime”.
  • Accessories –  Ensure all footwear and exercise equipments meets the required standard to prevent a re-injury.
  • No Big Break – Stress fracture can easily develop into a typical bone fracture if gone untreated.  Limitations early can help you avoid the “big break”.

How To Eliminate Heel Pain

In order to eliminate heel pain, we have to know what causes heel pain? Although the term heel pain is somewhat general, if you suffer from the condition you can testify to the significance of the injury.  The source of the pain in the arch area on the underside of the foot can vary.

Heel pain can be due to a trauma such as forcefully striking the heel on a hard surface or it may be an overuse injury, such as plantar fasciitis.

The calcaneus bone, or heel bone, has a thick layer of fat and protective fascia on its underside to provide padding as it makes contact with the ground.  Excessive forces or repetitive pounding of the heel can cause the fat pad to move or become inflamed.  When the protective layer under the heel bone decreases in efficiency like this, heel pain and burning feet can result.

Common Sources of Heel Pain:

  • Plantar Fasciitis – A common source of arch pain, this inflammatory process involves the plantar fascia, which enters into the back of the arch.
  • Heel Bone Spur – This occurs when excessive bone forms under the calcaneus(heel).
  • Heel Contusion – Known as a bruising of the heel bone.
  • Calcaneal Stress Fracture – This is a preliminary or significant fracture of the calcaneus bone.
  • Tarsal tunnel syndrome – This happens when the nerves encroach the back of the foot and arch.
  • Calcaneal bursitis – Is inflammation of the sack of fluid which sits under the heel
  • An increased warmth and possible swelling of the underside of the heel bone.
  • Arch pain originating on the heel and possibly extending into the underside of the foot towards the toes.
  • Posterior heel pain with weight bearing on the foot, which may worsen with active toe flexion.

Signs & Symptoms

  • Tenderness anywhere associated with the surface of the heel bone.
  • An increased warmth and possible swelling of the underside of the heel bone.
  • Arch pain originating on the heel and possibly extending into the underside of the foot towards the toes.
  • Posterior heel pain with weight bearing on the foot, which may worsen with active toe flexion.

Professional Treatment for Heel Pain

  • Icing the entire heel bone with an ice bag, ice massage or, ideally, with an ice bucket.
  • Rest the area to minimize the pressure on the calcaneus.
  • Easy massage of the arch and toes.
  • Modify the shoes to increase the padding encompassing the heel bone to provide greater shock absorption.
  • Increased calf stretching to allow greater pain-free movement of the ankle joint.
  • Consider utilizing orthotics or arch supports, depending upon your lower extremity anatomical alignment and biomechanics.
  • Heel bone spur symptoms can be improved with treatment noted above and it may require surgery.


Receive The Best Care By Asking The Best Questions

To ensure you receive the best possible care for your injured foot, ask questions like a smart professional athlete who wants to safely return to his/her sport as quickly as possible.  Here’s what a pro athlete would ask his sports medicine specialist:

  1. Are you certain of the diagnosis?
  2. Do I need an x-ray to determine the extent of this injury?
  3. What are my options with treating this injury?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert heel pain rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Tips to Quickly Recover from Heel Pain

  • Start Treatment Fast – Arch pain and heel pain are not injuries to ignore.  Start the treatment fast and this injury can usually be resolved quickly with minimal downtime.
  • Sole Searching – The shoes are typically the source of your problem.  Old shoes, improper shoes and worn shoe soles are common factors that lead to arch pain and burning feet.
  • Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pro’s will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.
  • What to Expect – The recovery time for heel pain is typically minimal.  As long as there is no stress fracture, large bone spur or significant plantar fasciitis, the downtime for this injury can range from a couple of days to a few weeks.  Treat it early to determine the source(s) of the problem, correct it and you’ll be back in the game before anyone knew that you were icing your heel!