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Stress Fractures

What are Stress Fractures?

Stress fractures are tiny cracks that form in a bone after repetitive stress. As a type of overuse injury, stress fractures are common in athletes of all levels, particularly with a sudden increase in training volume or intensity.

Stress fractures occur most commonly in the bones of the foot and lower leg.

Tibial stress fractures (stress fractures of the shin bone): the most common fracture; often occurs in runners of all levels (3). Most tibial stress fractures occur in the lower portion of the bone, closer to the foot.
Fibular stress fractures: another common stress fracture of the lower leg. The fibula bone is located on the outside of your lower leg and forms the outside of the ankle.
Calcaneal (heel) stress fractures: are most commonly found in long-distance runners and endurance athletes.
Metatarsal stress fractures: occur in the long, thin metatarsal bones of the front of the foot. Fractures often occur in the second and third metatarsal bones as they bear more relative force in activities like running.
Navicular stress fractures (fractures of a bone in the arch of your foot): often occur with activities that involve explosive or lateral (side-to-side) movement.

Symptoms of Stress Fractures:

While the most common symptom of a stress fracture is focal pain at the site of the fracture, other symptoms may include:

Tenderness to the touch
Localized swelling over the area of injury
Pain with everyday activities that subsides with rest
Unexplained pain at night or at rest

Symptoms can vary in intensity between individuals, and there may be periods of time where symptoms are more intense than others.

Risk factors for Foot Stress Fractures include:

While stress fractures can affect a wide variety of people, there are several risk factors associated with developing them:

Gender differences – Stress fractures are seen more often in female patients than males. While the literature is mixed as to why this is, some suggest that in females, the increase in the Q-angle at the hips increases the load on the lower leg and foot, increasing the risk for stress fractures (4).
High-impact activities – Activities that place a large amount of stress on the bones and tissues of the foot and lower limb can contribute to the development of stress fractures. Running, basketball, tennis, and soccer are all high-impact activities that can cause stress fractures in the feet (4).
Poor nutrition – Nutritional deficiencies, particularly in vitamin D and calcium, have been linked to a reduction in bone density. Loss of bone density increases the risk for stress fractures, as the bones become weakened (4).
Poor shock absorption – A more rigid, higher-arched foot is less able to absorb shock and, as a result, will transfer more shock through the bones of the foot or up through the tibia (shin). This increase in shock transfer can increase the risk of a stress fracture in the foot and lower leg (4).
Overpronation – Excessive pronation (collapse of the arch) can place an excessive amount of torsion on the tibia (shin bone). Repetitive torsion of the tibia can lead to stress fractures in this bone (4).

Treatment for Stress Fractures

Treatment for stress fractures depends on the severity and location of the fracture. Most stress fractures take six to eight weeks to heal completely.

Your primary care provider is the best initial resource for this injury. They will be able to recommend lifestyle or activity modifications or medications as well as order any necessary imaging or diagnostic tests. Your doctor may recommend using crutches or a removable cast walker to keep weight off the affected foot/leg.

Physiotherapists and kinesiologists can help with activity modifications and training changes to help manage your pain while remaining active.

A pedorthist can help control excessive movements at the foot that impact the alignment and movement at the knee. Your pedorthist may recommend a specific shoe or incorporate orthotics for stress fractures to correct these movements and realign the lower limb.

More severe stress fractures may require surgery to heal completely. In these cases, the surgeon will use pins, screws, or plates to hold the bones in place while they heal.

Physiotherapists can help with strengthening, stretching, and alignment issues that are impacting your pain. They may also be able to provide taping or other modalities to control pain and symptoms.

Kinesiologists can help you modify your activity or training to reduce your pain. After recovery, they can assist you in developing safe, gradual training programs to avoid future injury.

Staying active with a plan

The best therapy for healing a stress fracture, particularly in the lower leg or foot, is to abstain from all weight bearing activity. Some substitutions for weight-bearing activities might include:

Resistance training
Handbike
Yoga
Swimming
Pilates

1. Patel D S, Roth M & Kapil N. Stress Fractures: Diagnosis, Treatment and Prevention. American Family Physician. 2011;83(1):39-46
2. Baxter M L, Baycroft C, & Baxter G D. Lower limb injuries in soldiers: Feasibility of reduction through implementation of a novel orthotic screening protocol. Military Medicine, 2011;176(3):291-296
3. Heaslet M W & Kanda-Mehtani S L. Return-to-activity level in 96 athletes with stress fractures of the foot, ankle and leg. Sports Medicine of the Lower Extermity 2007;97(1):81-84
4. Bennell K, Matheson G, Meeuwisse W, Brukner P. Risk Factors for Stress Fractures. Sports Med 1999;28(2):91-122

Don’t let Stress Fractures get you down. Get back on your feet, today.

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How can SoleScience help your stress fracture feel better?

If your foot and lower limb mechanics are part of the cause of your stress fracture, SoleScience can help! Using footwear, off-the-shelf orthotics, or custom-made orthotics, your SoleScience Pedorthist will create an individualized treatment plan that suits your specific needs. We will work with you to determine not only what we need to do to address your current concerns, but also to prevent future problems.

With stress fractures, there are two main biomechanical issues that might have caused – or contributed to the development of – a stress fracture:

You have a high arched foot that does not absorb shock well. In this case, the bones, muscles, and other tissues of the foot are not moving well to absorb the shock of your activity. As a result, the shock moves through the bones, rather than being absorbed by the soft tissue, leading to injury. This is commonly a factor in stress fractures in the foot.
You have a hypermobile foot that has a large range of motion. In this case, your foot is moving to excess, causing a high amount of twisting or torque to be put through some of the bones in the foot and lower leg. As a result of this torque or twisting, a stress fracture can result. This is commonly a factor in stress fractures of the lower leg.

Custom foot orthotics can help by either absorbing the shock or reducing excessive movement, thereby reducing the stress on the bones in the foot and lower leg.

Your pedorthist will complete a thorough and comprehensive foot examination and gait analysis at your initial appointment, as well as a thorough follow-up exam at your regularly scheduled follow up appointments. During these appointments we will:

Assess joint and muscle function, including range of motion and gait assessment
Assess your footwear for both fit and function
Identify any risk factors that can be modified and make recommendations for change
Identify excessive movements, abnormalities, or joint restrictions that may be causing your pain
Perform special testing to determine the nature of your injury
Discuss changes to your foot care plan, which might include a change in footwear, activity modification, or custom foot orthoses

In addition to your individual treatment plan, your SoleScience Pedorthist will provide you with educational resources to help you best maintain your foot health.

Our take on the need for custom foot orthoses

Stress fractures are common injuries that begin with repetitive and excessive stress on the bone (1). Strenuous exercise, physical labor, and rapid changes in your physical activity level are often the precipitating factors in the development of a stress fracture. Both off-the-shelf and custom orthoses have been shown to be an effective treatment in both reducing the incidence of stress fractures and treating their symptoms (2, 3).

In many cases, your biomechanics may be the cause of your injury. On both ends of the spectrum, excessive movement and reduced movement, can contribute to stress fractures. In these cases, orthotics can help by reducing the mechanical cause of your injury and preventing re-injury from happening in the future. In other cases, your biomechanics may simply be slowing your recovery or preventing the injured tissue from healing. In these cases, orthotics might be an instrumental tool in your recovery, but might not be required long-term.

Custom foot orthoses are made using a mold (cast) of your foot. This type of insole is made specifically for you and your needs. Your pedorthist will not only take a cast of your foot in a specific position but also choose the materials and construction details tailored specifically to you. For those with more complex biomechanical issues or who have been suffering from more chronic symptoms, a custom device may be right for you.

Off-the-shelf (OTS) devices are pre-fabricated for an “average” foot and are designed to slip into most footwear. This type of insole may be heat moldable, or modifiable for a degree of customization, but is not entirely custom-made to your foot. For those who have mild symptoms and have only been experiencing pain for a short time, an OTS device may be right for you.

Footwear recommendations

Selecting appropriate footwear for your activity and lifestyle is important for everyone, especially those who are injured. Specific recommendations for shoes to relieve symptoms associated with stress fractures in the feet depend on your individual mechanics and foot type, but generally speaking, footwear with a stable base of support and ample midsole cushioning work well when dealing with Stress fractures. Wearing shoes that are fit correctly is equally important when managing any injury.

Make a confident choice in SoleScience, and we’ll do everything in our power to make you a raving fan!

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