Recognising and Treating Stress Fractures in the Foot

Stress fractures are small cracks or severe bruising within a bone. They are common injuries in the foot, often resulting from repetitive activity or overuse. Understanding how to recognise and treat stress fractures is crucial for preventing further injury and ensuring a swift recovery. This guide by Manly Cove Podiatry will help you identify the symptoms, understand the causes, and explore treatment options for stress fractures in the foot.

What is a Stress Fracture?

A stress fracture is a tiny crack in a bone caused by repetitive force, often from overuse, such as repeatedly jumping up and down or running long distances. They can also develop from normal use of a bone that has been weakened by a condition such as osteoporosis. Stress fractures are common in weight-bearing bones of the foot and lower leg, as these areas endure significant pressure and impact with each step. 

Unlike acute fractures, which occur from a single traumatic event, stress fractures develop over time and are typically caused by repetitive activities that place excessive stress on the bone.

Causes of Stress Fractures in the Foot

Several factors can contribute to the development of stress fractures in the foot:

  1. Overuse: Engaging in high-impact activities, such as running, jumping, or dancing, without adequate rest periods.
  2. Sudden Increase in Activity: Rapidly increasing the intensity, duration, or frequency of physical activity without allowing the body to adjust.
  3. Improper Footwear: Wearing shoes that do not provide adequate support or cushioning, especially during high-impact activities.
  4. Bone Insufficiency: Conditions like osteoporosis or other metabolic bone diseases that weaken the bones and make them more susceptible to fractures.
  5. Biomechanical Issues: Abnormal foot mechanics, such as flat feet or high arches, can increase stress on certain areas of the foot.
  6. Nutritional Deficiencies: Lack of essential nutrients, particularly calcium and vitamin D, which are crucial for bone health.
  7. Previous Injuries: Having a history of stress fractures or other foot injuries can increase the risk of recurrence.

Recognising Symptoms of Stress Fractures

Recognising the symptoms of a stress fracture early can help prevent further injury and ensure timely treatment. Common symptoms include:


Gradual onset of pain that worsens with weight-bearing activities and improves with rest. Pain may become constant and severe over time if the stress fracture is not treated.


Swelling in the affected area may be accompanied by tenderness to touch. The swelling can be localised or spread across a larger area of the foot.


Mild bruising around the site of the fracture can indicate underlying damage.

Changes in Foot Shape

Visible changes in the foot’s structure or abnormal positioning due to pain and swelling.

Difficulty Walking

Limping or difficulty walking, especially after prolonged activity or weight-bearing.


Localised tenderness when pressing on the specific area of the bone where the fracture has occurred.

Diagnosis of Stress Fractures

Diagnosing stress fractures involves a combination of clinical evaluation and imaging tests to confirm the presence and location of the fracture:

Medical History

A thorough review of the patient’s medical history, including details of their physical activities, previous injuries, and any underlying conditions that may affect bone health.

Physical Examination

The podiatrist will examine the foot, looking for signs of tenderness, swelling, and specific points of pain that indicate a stress fracture.

Imaging Tests

  • X-rays: While initial X-rays may not show stress fractures, follow-up X-rays taken a few weeks after the onset of symptoms can reveal changes in bone structure as the fracture begins to heal.
  • MRI: Magnetic Resonance Imaging is more sensitive than X-rays and can detect stress fractures early, showing both bone and soft tissue damage.
  • Bone Scan: A bone scan involves injecting a small amount of radioactive material into the bloodstream. The material accumulates in areas of high bone activity, highlighting stress fractures.
  • CT Scan: In some cases, a computed tomography scan may be used to provide a detailed image of the bone and surrounding structures.

Treatment Options for Stress Fractures

Treating stress fractures focuses on relieving pain, promoting healing, and preventing further injury. Treatment options include:

  • Rest and Activity Modification:
    • The primary treatment for stress fractures is rest. Avoid weight-bearing activities and give the bone time to heal.
    • Switch to low-impact activities, such as swimming or cycling, to maintain fitness without stressing the foot.
  • Protective Footwear:
    • Wearing supportive footwear or using orthotic inserts can help redistribute pressure and provide additional support to the foot.
    • In some cases, a walking boot or brace may be recommended to immobilise the foot and aid healing.
  • Pain Management:
    • Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain and reduce inflammation.
    • Applying ice packs to the affected area for 15-20 minutes several times a day can also alleviate pain and swelling.
  • Physical Therapy:
    • Once the initial pain and inflammation have subsided, physical therapy can help strengthen the muscles around the fracture site and improve flexibility.
    • A physical therapist can design a rehabilitation program to gradually return to normal activities without risking re-injury.
  • Nutritional Support:
    • Ensuring an adequate intake of calcium and vitamin D is essential for bone health and healing. Consider supplements if dietary intake is insufficient.
  • Surgical Intervention:
    • In rare cases where the fracture does not heal with conservative treatment, surgical intervention may be necessary. This could involve inserting pins, screws, or other hardware to stabilise the bone.

Recovery and Rehabilitation

Recovery from a stress fracture involves a gradual return to normal activities while ensuring the bone heals properly:

  • Gradual Resumption of Activity:
    • Begin with low-impact activities and slowly increase intensity based on comfort and pain levels.
    • Avoid high-impact activities until the fracture is fully healed and cleared by your healthcare provider.
  • Strengthening Exercises:
    • Engage in exercises to strengthen the muscles around the affected area, improving stability and support for the bone.
    • Focus on exercises that enhance overall foot and ankle strength and flexibility.
  • Monitoring Symptoms:
    • Keep track of any recurring pain or discomfort during the recovery period. Persistent symptoms may indicate incomplete healing or the need for further evaluation.
  • Follow-Up Appointments:
    • Regular follow-up appointments with your podiatrist are essential to monitor healing progress and make any necessary adjustments to your treatment plan.
  • Preventive Measures:
    • Implement preventive measures such as wearing appropriate footwear, gradually increasing activity levels, and maintaining a balanced diet to support bone health.

When to Seek Professional Help

While self-care and preventive measures are crucial, there are times when professional help is necessary. Seek help from a podiatrist or healthcare provider if you experience:

  • Persistent Pain: Pain that does not improve with rest and self-care measures, or pain that worsens over time, requires professional evaluation.
  • Swelling and Bruising: Significant swelling or bruising in the foot, especially if accompanied by severe pain, should be assessed by a healthcare professional.
  • Difficulty Walking: Limping or difficulty bearing weight on the affected foot indicates the need for medical intervention.
  • Visible Deformity: Any visible deformity or abnormal changes in the foot structure should be examined by a podiatrist.
  • Signs of Infection: Redness, warmth, or discharge from the affected area may indicate an infection and require immediate medical attention.
  • Unresponsive to Treatment: If your symptoms do not improve with initial treatment or if you have recurrent stress fractures, further evaluation and treatment may be needed.

At Manly Cove Podiatry, our experienced team is dedicated to providing expert care for stress fractures and other foot conditions. Contact us if you experience any of these symptoms or need professional advice on managing your foot health.