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”.

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.

No One Can Ignore Metatarsalgia Foot Pain

Metatarsalgia is a general term relating to forefoot pain secondary to inflammation in the area of the distal foot and toes.  The swelling involves the joints that connect the metatarsal bones of the foot and the phalanges (toe) bones.  The 2nd, 3rd and 4th MTP joints are most often stricken with this disorder.  With the joints of the toes, Metatarsalgia is commonly found within the 2nd, 3rd and 4th interphalangeal joints.

Morton’s Neuroma is a similar condition that demonstrates with forefoot pain.  Unlike Metatarsalgia, Morton’s Neuroma pain is located between the distal metatarsal bones where Metatarsalgia is typically pain within the joints themselves of the forefoot and toes.

Morton’s Neuroma is caused by a pinching of the nerves between the 2nd, 3rd and 4th metatarsal bone creating an inflammation of the nerves.

Ball of the foot pain is not typically linked to either of these condition although it is not surprising to develop such symptoms by compensating for any lower extremity dysfunction.

Signs and Symptoms of Metatarsalgia

  • Forefoot and toe pain which increases with weight bearing activities.
  • Tight fitting shoes and high heels increase symptoms.
  • Point tenderness pain in the distal foot area and proximal toes.
  • Excessive blistering, callus and wear patterns are commonly found in the forefoot and toes.
  • Passive bending and rotating of the toe will increase pain.
  • Ball of foot pain can be present which tends to be more related to compensation mechanics with chronic foot pain symptoms.
  • Long-term abnormal toes alignment such as claw toes or bunions may be contribute to the condition.
  • There may be excessive skin or calluses under the foot due to excess pressure.

Sign and Symptoms of Morton’s Neuroma

  • Localized pain between the 3rd and 4th distal metataral bones and toes.
  • Complains of increased weight bearing symptoms as if they are “standing on a pebble”.
  • Pain increases with weight bearing activities.
  • Symptoms into the distal foot and toes can include sharp pain, burning, numbness and/or tingling.
  • Increased symptoms between the metatarsal bones with squeezing of the forefoot.
  • Excessive callus and wear patterns are commonly found under the distal forefoot and great toe.
  • Ball of foot pain can be present which tends to be more related to compensation mechanics with chronic foot pain symptoms.

Treatment for Metatarsalgia and Morton’s Neuroma

  • Aggressive icing of 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 the activity you are performing
  • Minimize activities that include weight bearing.
  • Massage and soft tissue treatments to the arch, great toe, ankle joint and calf.
  • Biomechanical evaluation to assess contributing issues such as: a leg length discrepancy, hyper pronation/supination, tight ankles, restricted toe extensor tendons, hypomobile toes, knee, hip or low back factors.
  • Consistent calf stretching.
  • Orthotics with possible rigid steel insert of ball of foot pain is present.

Questions a Pro Athlete Would Ask

A smart professional athlete with Metatarsalgia who wants to safely return to his/her sport should ask his sports medicine specialist the following questions:

  1. Do you have any concern that I may have stress fracture in my foot or toes?
  2. Is there any chance that some of my foot symptoms are coming from nerves in my back or leg?
  3. Will orthotics help me and if so, where can I get them at a reasonable price?
  4. If you had this same problem, where would you go to do your therapy?

Sports Medicine Tips

If the Shoe Doesn’t Fit, Don’t Wear It – True fact:  woman’s shoes are the best invention for the foot doctor profession.  They look sexy and stylish but they are killing your feet.  Ladies or dudes:  You know that it’s true so get rid of any shoes that are creating foot problems.

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 foot and arch pain.

#2 Pencil – Using the eraser end, use it to apply pressure between the metatarsal bones of the foot.  It’s a simple tool to help determine the location of the pain and the diagnosis.

Ice is Your Friend – It’s a reality check:  Ice hurts but it’s exactly what you need for this injury.  The Pros will tell you that ice is their best teammate.  Stop complaining and do what you know you need….ICE and lots of it.