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Stress Fractures of the Foot and Ankle

Foot or Ankle Pain


Forefoot pain can be a stress fracture of the bone. A stress fracture is a small crack or severe bone bruise in the foot or ankle. Stress fractures, unlike an acute fracture, is brought on by overuse. The bones in the body are constantly being replenished with bone stock, but if you have been much more active than usual a stress fracture may occur. This happens as a result of the body not having time to rebuild the bone.


Stress fractures are more common in sports people and athletes, and more common in women than men. If you have increased your training volume, training intensity or changed running or training surface you may get a stress fracture. Wearing shoes that reduce the foot’s ability to absorb stress can cause a stress fracture.


Other causes of stress fractures can be a less than optimal bone stock. This can occur if you have had or have health issues, have spent very little time weight bearing or have a poor nutritional intake.


You may have a stress fracture of the foot or ankle if you:


  • Experience pain when weight bearing
  • If there is swelling of the foot or ankle
  • You see a bruise on your foot or ankle



Stress fractures are usually caused by repetitive stress on the foot or ankle that it is not used to. Increasing your training volume too quickly or starting a new sport without giving your body time to get used to the new activity your bones and muscles haven’t got time to increase in strength to gradually adapt to the new activity. Your bodies weight bearing bones are especially vulnerable to stress fractures as they absorb repetitive forces from running, walking and sports.


If you are getting pain in the foot, it’s not advised to try to walk through the pain. A stress fracture that is ignored can lead to an complete fracture. See your podiatrist who can ultrasound scan your foot or ankle for stress fractures. An ultrasound scan is usually more accurate than an x-ray for stress fractures as an x-ray will not show a stress fracture until a few weeks have gone by. An x-ray can sometimes be requested in particular circumstances.

Treating bone injuries depends on the severity, the bone that’s injured and your overall health. You should in all cases stop any high impact exercise to let the bone heal: See the podiatrist.

The most common areas for stress fractures are the metatarsals, the heel bone and the tibia and fibula.


x-ray of metatarsal stress fracture

Preventing stress fractures

If you are starting a new sport or starting running, we recommend a strengthening program. You can alternatively try some cross training as this can have some effect on increasing your bone and muscle strength.

In particular novice runners are advised to see the podiatrist for a running analysis where some minor adjustments can be made to reduce the risk of a stress fracture or soft tissue injury. A podiatrist can also give you a strengthening program.

Start your new activities slowly. This will give your body time to adapt. Don’t train every day if you haven’t been active for a while even if you start to see improvements early on.

Mix up your activities so your body gets trained in different ways. This will reduce the risk of overtraining certain parts of your body.

If you get pain and swelling, stop your activity for a few days and if you get the same pain recurring when you train again, see the podiatrist.


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