Stress Fractures

Diagnosing the cause and optimal treatments for Stress Fractures.

Stress fractures are an overuse injury that mostly occur in the weigh bearing joints of the lower limbs and feet. This is due to the increase amount of pressure and stress placed on these bony structures.

If the muscles in the lower limb and foot are overused they become weak and tired and are no longer able to assist in shock absorption on impact. This results in increased stress and work on the bones, which may lead to hair line cracks from repetitive accumulated stress.

Stress fractures are very common in athletes, especially runners, basketballers, dancers and gymnasts. This is because they are directly related to the frequency, duration and intensity of training and physical activity.

Hairline fractures are however not dependant on age, gender or level of physical activity and often can occur with minimal history of  preceding trauma.


Causes of Stress Fractures:

  • Increase volume of training, excessive training or initiating a new training regime.
  • Hard surfaces on impact.
  • Errors in training or technique.
  • Poor foot function (which affects shock absorption when the foot strikes the ground, and increases muscle fatigue).
  • Pathologies such as bunions, cornstendon injury and blisters, which alters the biomechanics of the feet due to pain and poor function.
  • Bone insufficiency, such as osteoporosis.
  • Menopause (which decreases calcium levels/ bone density and strength).
  • Certain medications that decrease bone density.

Symptoms of Stress Fractures:

  • Gradual pain on weigh bearing activities and relief with rest.
  • Mild swelling and increased warmth in affected area.
  • Possible bruising.
  • Tender to touch.

Treatment for Stress Fractures:

  • Initially rest, ice, compression and elevation of the injured area.
  • Anti-inflammatory medication for inflammation and pain if required.
  • Reduce activity.
  • Revising training regimes (pool running/cycling).
  • Revising training surfaces (grass/sand).
  • Orthotic therapy (to decrease mechanical forces).
  • Appropriate footwear which is activity specific.
  • Stress fractures of the 5th metatarsal, navicular and talus take longer to heal and may require immobilisation.
  • Surgery to fixate bones with pins and screws if severe and non responsive to conservative treatment.

Caution:Untreated stress fractures may result in complete fractures of the bone which could require surgery and extensive recovery periods.

At Well Heeled Podiatry the podiatrist will ask you about many lifestyle factors including, work, physical activities (frequency, duration, intensity), training surfaces, medications etc to get and idea on your risk level for developing stress fractures.

Your footwear will be assessed as well as your lower limb biomechanics and foot function. Diagnostic X-rays may be taken to confirm or exclude stress fractures if you are experiencing the above symptoms.

Hairline fractures are difficult to see in their initial stages. Further investigations, such as bone scans and MRI may need to be undertaken for a definitive diagnosis.

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