Managing a Foot Stress Fracture the Right Way

Managing a Foot Stress Fracture the Right Way

A stress fracture in the foot is usually associated with an overuse injury to weight-bearing bones. Most athletes affected are involved in high-impact sports that involve running and jumping such as distance running, basketball, tennis, and football.

Bones generally respond to stress by hardening along their outer margins. When suddenly exposed to strong forces or ongoing stress, there is little time for bones to adapt.  Meanwhile, muscles associated with the feet lose their shock-absorbing capacities when fatigued. These uncontrolled forces inadvertently transfer to nearby bones, possibly resulting in small cracks that are better known as stress fractures.

Foot pain caused by stress fractures generally occurs on the top portion of the foot but can also radiate along the heel, side of the foot, and within the ankle joint itself.  Stress fractures commonly occur along the outer ridge of the forefoot over the fifth metatarsal bone. This is often referred to as either a Jones fracture or a Dancer’s fracture, depending on location.

Individuals with a stress fracture usually experience increased pain with movement and, as the condition worsens, even while resting.

Sources of Sore Feet

High-impact activities that result in overuse and put frequent pressure on the lower extremities can lead to stress fractures, such as running, soccer, football, basketball, gymnastics, etc. 

Wearing footwear with little to no shock-absorbing capacities is another contributing factor. Women are more likely to be affected than men, possibly due to poor eating habits/eating disorders and disruptions in their menstrual cycle. Among both genders, excessive aerobic exercise with insufficient rest periods can also increase the chance of getting a stress fracture.

Notably, the presence of underlying bone diseases or disorders can drastically increase the risk for these painful foot conditions.

Signs & Symptoms of Stress Fractures in the Foot

  • Localized foot pain that is dull, aching or sharp and occurs during activity (especially running) and/or periods of rest
  • Mild-to-severe foot swelling and tenderness
  • Pain that worsens with prolonged exposure to ice and during sleep
  • An initial sensation of sharp pain followed by intensifying aching  
  • Localized discoloration and possible stiffness in surrounding joints

Professional Treatment for Stress Fractures

  • Get plenty of rest and apply ice.
  • Consult a physician early on to obtain an exam, X-rays and special testing, if necessary.
  • Avoid placing excessive weight on the affected foot.
  • Wear shock-absorbing footwear, and if symptoms worsen, use a walking boot to help mitigate stress on the injury site.
  • Use a non-weight bearing cast and crutches, if necessary.
  • Eat healthy and ingest the Recommended Daily Allowance (RDA) amounts of calcium and Vitamin D to help restore bone integrity.
  • When symptoms improve, engage in strength training for the arch, toe flexors and weak muscles in the lower extremity.
  • Maintain an ideal range of motion for the surrounding muscles and joints, specifically the Achilles, calf, plantar fascia, great toe and ankle joint.

Ask the Right Questions like a Pro

Here’s what smart pro athletes would ask a sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. What do you believe is the main reason(s) why this injury occurred?

2. Are diagnostic tests necessary to further assess the injury?

3. How can I best manage this pain and get back to my sport?

4. What non-surgical treatment options are available, if any?

5. Do I have any leg length disparities or other biomechanical abnormalities that require orthotics or other treatment to avoid long-term foot pain issues?

Elite Sports Medicine Tips from Mike Ryan

  • Time is of the Essence –  Visit a sports medicine specialist as soon as symptoms appear to best manage foot pain from the onset.
  • Rest Rocks –  It’s boring, but REST is the #1 tool to tame a stress fracture.  For how long, you ask?  Prepare yourself for 2 to 6 weeks of inactivity if symptoms persist. 
  • Proceed with Caution – Resume your pre-injury activities at a slow pace, adding strengthening and stretching exercises to your routine.
  • Mix it Up –  Cross Training is king. Add varied activities such as biking, swimming, yoga, and elliptical training to stay in shape and save your “marriage” during this break from activity.
  • Accessorize Appropriately – Ensure all footwear and exercise equipment meet the required standards to prevent re-injury.
  • No Big Break – Stress fractures can easily develop into typical bone fractures if left untreated.  Setting limitations from the get go can help you avoid the “big break.”

Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain secondary to inflammation in the area of the distal foot and toes.

Metatarsalgia: Foot Pain’s Evil Brother

Metatarsalgia is a general term relating to forefoot pain, secondary to inflammation in the distal foot and toe area.  Joints that connect metatarsal foot and toe bones become swollen, and the second, third, and fourth MTP joints are most often affected.  Additionally, Metatarsalgia is commonly found within the second, third, and fourth joints between the toes.

Morton’s Neuroma is a similar condition that presents with forefoot pain.  Unlike Metatarsalgia, Morton’s Neuroma pain is located between the distal metatarsal bones as opposed to within the forefoot and toe joints themselves.

Morton’s Neuroma is caused by pinched nerves located between the second, third, and fourth metatarsal bones, resulting in nerve inflammation.

Pain in the ball of the foot is not typically linked to either of these conditions, although it is not surprising to develop this symptom by compensating for lower extremity dysfunction.

Signs and Symptoms of Metatarsalgia

  • Forefoot and toe pain that increases with weight-bearing activities
  • Symptoms that worsen when wearing tight-fitting shoes or high heels
  • Point tenderness pain in the distal foot area and proximal toes
  • An excessive pattern of blisters, calluses and wear and tear in the forefoot and toes
  • Increased pain from passive toe bending and rotating
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)
  • A contributing factor of long-term abnormal toe alignment, such as claw toes or bunions 
  • Excessive skin or calluses underneath the foot due to excess pressure

Signs and Symptoms of Morton’s Neuroma

  • Localized pain between the third and fourth distal metatarsal bones and toes
  • An increase in weight-bearing symptoms, such as feeling as if you are  “standing on pebbles”
  • Increased pain with weight-bearing activities
  • Sharp pain, burning, numbness and/or tingling in the distal foot and toes
  • Increased symptoms between the metatarsal bones when squeezing the forefoot
  • Excessive callus and wear patterns under the distal forefoot and great toe
  • Pain in the ball of the foot (related to compensation mechanics that sometimes present with chronic foot pain)

Treatment for Metatarsalgia and Morton’s Neuroma

  • Aggressively ice the arch, foot and toes with ice bags, ice massage or (ideally) an ice bucket, for 10 to 15 minutes.
  • Wear the proper footwear for specific activities.
  • Minimize weight-bearing activities.
  • Massage and apply soft-tissue treatments to the arch, great toe, ankle joint and calf.
  • Perform a biomechanical evaluation to assess contributing factors such as a leg length discrepancy, hyper pronation/supination, tight ankles, restricted toe extensor tendons, hypomobile toes, or knee, hip or low back conditions.
  • Stretch your calves on a consistent basis.
  • Wear orthotics, ideally with a rigid steel insert, when experiencing pain in the ball of the foot.

Questions a Pro Athlete Would Ask

Here’s what smart pro athletes would ask their sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. Are you concerned that I may have a stress fracture in my foot or toes?

2. Could my foot symptoms be related to nerves in my back or leg?

3. Will orthotics help, and if so, where can I find them at a reasonable price?

4. If faced with this same problem, where would you go for therapy?

Sports Medicine Tips

If the Shoe Doesn’t Fit, Don’t Wear It – It’s a fact that women’s shoe designs help keep foot doctors in business.  They may look sexy and stylish but are absolute killers for the health of your feet.  Ladies (and gentlemen) – rid your closet of any ill-fitting shoes ASAP!

Do Some Sole Searching – Assess the overall health of your shoes in addition to your feet. Wearing old, “expired” shoes with worn soles is a common factor that leads to foot and arch pain.

(Yet Another) Test with a #2 Pencil – Using the eraser end, apply pressure between the metatarsal bones of the foot to help pinpoint the location of the pain and lead to a diagnosis.

Ice is Your Friend – I’m sorry, but it’s true – the bitter chill of ice is necessary to treat this injury.  The pros will tell you that ice is their best teammate.  Stop complaining and stock your freezer accordingly!