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. It commonly develops in the weight-bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress; when this happens, the muscles transfer the stress to the bone, which can result in a stress fracture.

Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by an impact on a hard surface, improper footwear and increased physical activity. Athletes participating in certain sports, such as basketball, tennis or gymnastics, are at a greater risk of developing stress fractures. During these sports, the repetitive stress of the foot striking against a hard surface can cause trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop a stress fracture.

Women are at a greater risk of developing stress fractures than men. This 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 fractures increase in women when the bone weight decreases.

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

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


Stress fractures can be treated by a non-surgical approach, which can include rest and limiting the physical activities that involve the foot and ankle. If children return too quickly to the activity that has caused the stress fracture, it may lead to chronic problems such as harder-to-heal stress fractures. Re-injury can also occur without allowing the stress fracture to completely heal.

Protective footwear may be recommended to reduce stress on the foot. Your doctor may apply a cast to the foot to immobilize the leg, which also helps to remove the stress. Crutches may be used to prevent weight-bearing on the injured foot until the stress fracture has healed completely.

Surgery may be required if the fracture has not healed completely by non-surgical methods. Your doctor makes an incision on the foot and uses internal fixators, such as wires, pins or plates, to attach the broken bones of the foot together until complete healing of the bones, after which, these fixators can be removed or may be permanently left inside the body.

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

  • Ensure to start a new sport activity slowly and progress gradually.
  • Cross-training: You may perform 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 stress occurring on specific muscles as different activities use muscles in different ways.
  • Ensure to maintain a healthy diet and include calcium and vitamin D-rich foods in your diet.
  • Ensure that your child uses proper footwear or shoes for any sports activity, while avoiding old or worn out shoes.
  • If your child complains of pain and swelling, then immediately stop the activities and make sure that your child rests for a few days.