ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
 540 BRYANT ST, PALO ALTO, CA 94301
(650) 815-6552

Voted Best Sports Therapy Clinic in the San Francisco Bay Area 2010-2016!

Foot Stress Fracture

(Also known as Stress Fracture of the Foot)
 
What is a stress fracture of the foot?
A stress fracture of the foot is a condition characterized by an incomplete crack in one of the foot bones.
The foot comprises of many small bones seven of which are located in the rear foot and are collectively known as the tarsals. The mid foot comprises of five long bones known as the metatarsals. The toes each comprise of several small bones known as the phalanges. Each bone within the foot forms joints with adjacent bones.
The bones of the foot provide attachment points for many muscles of the lower leg and foot. When these muscles contract, a pulling force is exerted on the respective bone. In addition, weight bearing activity places stress on the bones of the foot. When these forces are excessive or too repetitive, and beyond what the bones of the foot can withstand, bony damage can gradually occur. This may initially result in a bony stress reaction, however, with continued damage may progress to a stress fracture of the foot.

Cause of a stress fracture of the foot

A stress fracture of the foot typically occurs over time with excessive weight bearing activity such as distance running, sprinting, jumping or dancing. They often occur following a recent increase in activity or change in training conditions (such as surface, footwear or technique changes etc). A stress fracture of the foot may sometimes occur traumatically such as landing onto a hard surface from a height.

Signs and symptoms of a stress fracture of the foot
Patients with a stress fracture of the foot typically experience a localized pain in the foot, toes or ankle that increases with impact activity (such as running, jumping, sprinting and hopping) and may decrease with rest. As symptoms worsen, the patient may limp during weight bearing activity and may have to stop activity due to pain.
Occasionally, pain may radiate to other areas of the foot that are not specifically involved in the injury. In severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache or pain on firmly touching the affected bone.

Diagnosis of a stress fracture of the foot
A thorough subjective and objective examination from a physician may be sufficient to diagnose a stress fracture of the foot. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury.

Prognosis of a stress fracture of the foot
With appropriate management, most patients with a stress fracture of the foot can make a full recovery (return to sport or full activities) in a period of 3 - 9 months. In more severe cases, recovery may take 1 year, or longer, depending on the intervention required and a range of other factors. In rare cases, some patients may experience ongoing symptoms or complications which may require further management.

Treatment for a stress fracture of the foot
Treatment for a stress fracture of the foot typically involves an initial period of rest from weight bearing activity. This may involve a period of non-weight-bearing immobilization in a plaster cast, the use of crutches or a protective boot for a number of weeks. Following this, a gradual increase in weight bearing activity and exercise can usually occur as tolerated, provided symptoms do not increase. This should take place over a period of weeks to months with direction from the treating therapist and will vary depending on the severity of the injury and how well the contributing factors have been addressed.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the stress fracture altogether. Immediate, appropriate treatment is essential to ensure a speedy recovery.
Manual "hands-on" therapy from the therapist such as massage, trigger point release techniques, dry needling, joint mobilization, stretches, and electrotherapy can assist with hastening healing, improving range of movement, pain and function and correcting factors that have contributed to the development of the stress fracture. This can generally commence once the therapist has indicated it is safe to do so.
Patients with a stress fracture of the foot should also perform specific pain free flexibility and strengthening exercises (following the initial period of immobilization) as part of their rehabilitation to ensure an optimal outcome. In addition, alternative activities which place minimal weight bearing forces through the affected bone should also be performed to maintain fitness (such as swimming, water running and, in some cases, cycling). The treating therapist can advise which exercises and activities are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation for a stress fracture of the foot, a gradual return to activity or sport can occur as guided by the treating therapist provided symptoms do not increase. This may involve a gradual return to running program to recondition the affected bone to running in a safe and effective manner.
Appropriate footwear advice and / or the use of orthotics may also be indicated in those patients whose lower limb biomechanics are likely to have contributed to the development of the stress fracture. Training technique or training methods may also need addressing to decrease the likelihood of injury recurrence.

Contributing factors to the development of a stress fracture of the foot
There are several factors which may contribute to the development of a stress fracture of the foot. These need to be assessed and corrected with direction from the treating therapist. Some of these factors include:
  • poor foot posture (especially flat feet or high arches)
  • muscle weakness (particularly of the gluteals, quadriceps, calf and core stabilisers)
  • poor balance
  • poor flexibility (particularly of the calf muscles)
  • joint stiffness (particularly of the ankle, heel or foot)
  • inappropriate footwear
  • poor running technique
  • inadequate diet
  • inappropriate or excessive training (particularly on hard or uneven surfaces)

Therapy for a stress fracture of the foot
Therapy treatment for patients with this condition is vital to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • joint manipulation
  • electrotherapy (e.g. ultrasound)
  • dry needling
  • the use of crutches
  • the use of a protective boot or brace
  • activity modification advice
  • taping
  • biomechanical correction (e.g. the use of orthotics)
  • technique correction
  • footwear advice
  • exercises to improve strength, balance, flexibility and core stability
  • education
  • a gradual return to running / activity plan

Other intervention for a stress fracture of the foot
Despite appropriate management, some patients with a stress fracture of the foot do not improve and require other intervention to ensure an optimal outcome. The treating doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization, use of crutches or protective boot, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the stress fracture of the foot. Occasionally, patients with this condition may require surgery to stabilize the stress fracture and aid healing.