Stress fractures are tiny, hairline cracks in the bone caused by repetitive force that can occur in the lower extremities including the foot.  If left untreated stress fractures can lead to a complete break in the foot.

Signs and Symptoms

  • Pain that comes on quickly during activity and is relieved by rest
  • Pain on the top of the foot or ankle
  • Swelling
  • Redness
  • Bruising

Who's at Risk


Runners and athletes who play basketball, tennis, or gymnastics.are most at risk. It's important for any athlete to increase their training schedule gradually.  


Increased activity in those who live a sedentary lifestyle: e.g. non-athletes who take up a new sport and push themselves too hard

Underweight Women Runners

A new study out of Ohio State University found that underweight women runners are at higher risk for stress fractures.Women with a BMI of 19 or lower were at higher risk than those runners with a higher BMI. The researchers thought that the reason for the higher risk in low weight runners is that the lack of soft tissue sends the shock of the constant pounding back into the bone. They agreed that more muscle mass was needed.

Female athletes who aren't getting proper nourishment and are training too hard can develop sporadic periods or lose their period altogether. This can cause bone low bone mass which sets a woman up for stress fractures.

This study also showed that it takes longer to heal from a stress fracture for those with a BMI of 19 or less. 

This idea of more muscle mass is echoed by Barbara Drinkwater, Ph.D who has studied bone health in master athletes. Many runners are often under the misconception that running provides enough weight bearing exercise to prevent stress fractures. Although much of her research has been on older women who have gone through menopause, her advice of weightlifting to build more muscle mass could extend to low weight women as well based on this study.

Women Athletes Who Are Post Menopausal

Post menopausal women are also at risk for stress fractures due to loss of bone mass.

Low Levels of Vitamin D

Vitamin D is essential to build strong bones

People With Poor Foot Mechanics

People with flatfoot or high, rigid arches are more at risk for stress fractures. Men and women with flat feet or other foot problems can end up placing more pressure on one area of their foot which prevents the bone from healing adequately. ‚Äč

Certain Foot Conditions

Bunions, tendonitis, and blisters can all affect the way your foot hits the ground adding more stress to your body.

Improper Footgear

Worn-out shoes or shoes not designed for your sport will not provide proper support for your feet, placing more stress on the bones. Athletic shoes need to be replaced every 500 miles. Learn more about how to buy supportive shoes by viewing this video.

Hard Running Surfaces

Our bones can be affected by a small change in the type of surface we run on. Shifting from trail running to running around Greenlake on cement or moving from playing tennis on an indoor surface to an outdoor surface can put you at risk for stress fractures.

Changing Jobs

Changes in how much you sit vs stand all day can also lead to stress fractures. For example, a person who changes from a job where they sit all day to one where they stand on their feet most of the day.


After confirming the problem through X-rays or other imaging, stress fractures are usually treating by recommending rest and by immobilizing the foot. Surgery may be needed to stablize the stress fracture or to repair a stress fracture that has progressed to a fracture.


Follow these recommendations to lower your risk for stress fractures:

  • Getting enough Vitamin D and eating a diet rich in calcium will give your body what it needs to keep your bones strong. Vitamin D levels that are too low will prevent your bones from absorbing calcium an essential ingredient for bone development.
  • Start training slowly particularly if you are more sedentary during the winter months; increase your training time by no more than 10% a week.
  • Add strength training to your workout regimen to build strong bones.
  • Change up your activities by alternating between ones that are high impact like running to low impact like swimming.
  • Stop when it hurts. Foot or ankle pain are never normal. 

For information about other types of heel pain visit:

What's Causing My Heel Pain and What Can I Do About It?

If you're noticing any of the symptoms above, it's important to make an appointment right away with a foot and ankle surgeon. Call us at 206-368-7000 or make an appointment online.