Stress fractures are tiny, hairline cracks in the bone caused by repetitive force that can occur in the lower extremities including the lower legs and foot.  If left untreated stress fractures can lead to a complete break in the foot. While athletes are most at risk, even non-athletes can develop a stress fracture.

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

Athletes 

Runners and athletes who play basketball, tennis, or gymnastics are most at risk.

Athletes Who Ramp Up Their Training Too Quickly

Bodies need time to recover. Ramping up your training too quickly can lead to a stress fracture. Consider increasing your training by only 10% a week and taking a rest week every 3-4 weeks. 

Non-Athletes

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

Runners Who Overstride

Overstriding has been shown to increase the force at which runners strike the ground putting them at greater risk for stress fractures. 

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

Wearing Wornout Shoes

Shoes that are worn out are not supportive and can add stress to your bones. 

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. 

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.

Treatment

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

Prevention

Follow these recommendations to lower your risk for stress fractures:

Obtain Over-the-Counter Inserts or Custom Orthotics

People with faulty foot mechanics such as flat feet or high arches will likely need over-the-counters inserts or custom orthotics to prevent stress fractures.

Buy Supportive Shoes Designed for Your Sport

Athletic shoes should be purchased every 500 miles. Make sure you buy shoes designed for your sport that are also stable and supportive. To test your shoes watch this video.

Get Proper Nourishment and Vitamin D

Underweight women in particular are at greater risk for stress fractures, particularly if they are athletes.

  • Eat a healthy diet rich in calcium and with enough calories to maintain proper weight.
  • Get enough Vitamin D to give your body what it needs to keep your bones strong through sun exposure, food, and supplements. 
  • Vitamin D levels that are too low will prevent your bones from absorbing calcium, an essential ingredient for bone development.

Adjust Your Training Schedule

Start training slowly particularly if you are more sedentary during the winter months; increase your training time by no more than 10% a week and take a rest week every 3-4 weeks. 

Stop Overstriding

Stop overstriding when you run if you have a tendency to do. Check out this guide from Runner's World.

Add Strength Training and Other Activities to Your Workout

  • Strength training can help 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

It shouldn't hurt when you run or are involved in other athletic acitivities. Foot or ankle pain are never normal. Stop your activities and get your pain checked out by your podiatrist. 

Learn more about other sports injury treatment here.

References:

Information about running and stress fractures are from The Ultimate Runner's Guide to Stress Fractures: Causes, Risk Factors, and How to Return to Training

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.