Out of all the different types of sports-related or activity-related foot and ankle injuries we treat at our office, stress fractures are often among the most frustrating for our patients.
It’s not because stress fractures are more painful than other types of chronic injuries, or more difficult to treat. In fact, in most cases, the recommended treatment approach for stress fractures of the feet could not be simpler or more straightforward. Rest and time are usually all that’s required.
So why are stress fractures so frustrating? Ultimately it comes down to temptation, discipline, and patience. We know you want to get back on the go as fast as possible, but there are many reasons why you need to be cautious. And fortunately, we can help you.
What Are Stress Fractures?
Stress fractures are tiny cracks that develop in the surface of a bone—as opposed to “full” fractures that cause a bone to snap or crack completely through, or avulsion fractures where a piece of bone is broken off.
Stress fractures usually start out as kind of a dull ache, in maybe a single spot on your foot. (The metatarsal bones of the midfoot are especially prone to stress fractures, although they can occur elsewhere.) Over time, however, the pain and tenderness get worse and worse, and cover a larger area.
Periods of rest will cause the pain to decrease, but exercise and other sustained activity will bring it roaring back.
What Causes Stress Fractures?
Typically, stress fractures occur in response to extended periods of overuse, where you’re subjecting your body to lots of impact forces without providing appropriate rest periods in between to recover.
With athletes, the typical pattern is that overuse causes the soft tissues underfoot to wear down, which means foot bones (especially the metatarsals in the middle of the foot) have to pick up more of the slack. Your bones try to adapt to this by “remodeling,” essentially breaking down the bone tissue in order to rebuild itself stronger. But if you short-circuit the process by continuing to subject your feet to heavy impact forces, the bones continue to weaken and eventually start to crack.
Some common risk factors include:
- Participating in high-impact sports or activities (running, basketball, track and field, dancing, gymnastics, backpacking, etc.).
- Suddenly increasing your activity levels over a short period of time (which doesn’t allow your bones to remodel themselves fast enough to prevent injury).
- Having relatively weak bones, due to a condition like osteoporosis or poor nutrition.
- Regularly wearing worn-out or unsupportive footwear, especially during activity.
- Having existing structural foot problems, such as flat feet or rigid high arches.
Why Treatment Is Often So Easy—and Yet So Hard
Here’s the problem that active people often face when dealing with stress fractures.
The actual mechanics of treatment are very straightforward in the vast majority of cases. Pretty much all you have to do is stop participating in high-impact activity and give your bones time to repair themselves. Surgery is almost never necessary. And if your stress fractures are mild, you may not even need any special interventions or equipment at all.
The problem is that stress fractures often require a lot of time to fully repair themselves—6 to 8 weeks is fairly typical. That’s a lot of time to be away from activity, especially sports you love (or occupations that require you to do a lot of walking and lifting).
Making it worse is that, in general, with most mild-to-moderate stress fractures, you usually can walk or even run on them—it just hurts a bit.
And even if the pain starts out pretty bad, as you go through your weeks of rest, the symptoms will continue to gradually improve. So you can imagine, it becomes very tempting for some people to cheat a bit and restart their activities. Unfortunately, the usual result is that all the work you just did gets undone, and you have to start over again.
Actually, it’s worse than that, because the longer your stress fractures stick around, the more likely they’ll deepen and even develop into complete fractures. Trust us: you don’t want to go there.
Helping You Heal
We understand what you’re going through, and we want to make sure you get all the support, guidance, and care you need to get rid of your stress fractures for good.
For more serious stress fractures, you may need a walking boot or crutches to really protect your foot and ensure you offload weight as much as possible.
Once you’re back in normal shoes, we may recommend further techniques to help you continue to heal and reduce your risk of reinjury while keeping your sanity:
- Making sure the shoes you wear provide solid cushioning and support
- Fitting you for a good pair of arch supports or custom orthotics that further offload weight and pressure from at-risk locations. (This will aid your recovery and, if you continue to use them, reduce the risk of future injury.)
- Providing clear, detailed guidelines for when and how you can start to return to your favorite activities.
- When possible, recommending alternative activities (such as swimming or sometimes cycling) that keep you active and mentally engaged without putting your feet at unnecessary risk.
Now, ultimately, there’s no way to avoid the fact that treatment is always going to require some time and patience. But if you take it seriously and come to see us, we’ll make sure you leave our office with a solid plan moving forward, so you feel supported and don’t have to try to make guesses about how to recover and rehab safely.