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Stress Fractures of the Foot and Ankle

A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight bearing bones of the lower leg and foot.

Stress fractures are associated with a rapid increase in the intensity of exercise. Athletes participating in certain sports such as distance running, and activities associated with over training such as ballet and gymnastics are at a greater risk of developing stress fractures. During these sports the repetitive stress of the foot strike on a hard surface causes micro-trauma. When the amount of micro-trauma exceeds the body’s healing ability, a stress fracture results.

Females are at a greater risk of developing stress fracture than males, and may be related to a condition referred to as “female athlete triad”. It is a combination of eating disorders, amenorrhea (irregular menstrual cycle), and osteoporosis (thinning of the bones). The risk of developing stress fracture increases in females if the bone weight decreases.

The most common symptom is pain in the foot which usually gets worse during exercise and decreases when resting. Swelling, bruising, and tenderness may also occur at a specific point.

Your doctor will diagnosis the condition after discussing symptoms and risk factors and after an examination of the foot and ankle. Some of the diagnostic tests such as X-ray, MRI scan or bone scan may be required to confirm the fracture.


Stress fractures can usually be treated by non-surgical approach which includes rest and limiting the physical activities that involves foot and ankle. Re-injury can also occur without allowing the stress fracture to completely heal.

Protective footwear may be recommended which helps to reduce stress on the foot. Your doctor may apply a cast to the foot to immobilize the leg which also helps to reduce the stress. Crutches may be used to further reduce the load to the foot until the stress fracture has healed completely.

Surgery may be required if the fracture does not heal completely with non-surgical treatment. Dr Hocking will need to makes an incision over the stress fracture and then use internal fixators such as wires, pins, or plates to bridge the broken bones of the foot. Bone graft may be required to facilitate healing.

Some of the following measures may help to prevent stress fractures:

  • Ensure to start any new sport activity slowly and progress gradually
  • Cross-training: You may use more than one exercise with the same intention to prevent injury. For example, you may run on even days and ride a bike on odd days, instead of running every day to reduce the risk of injury from overuse. This limits the micro-trauma and allows healing in between workouts.
  • Ensure to maintain a healthy diet and include calcium and vitamin D-rich foods in your diet
  • Ensure that you use supportive footwear or shoes for sports activities
  • If you develop pain with walking, stop sports activities and ensure pain has resolved before recommencing training/sports. See a physiotherapist if pain does not resolve within a few weeks.