Stress Fractures of the Foot and Ankle

Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by 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 strike on a hard surface causes trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop a stress fracture.

Females are at a greater risk of developing stress fractures than males, which sometimes may be related to a condition referred to as the “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 increases in females if the bone weight decreases.

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

Your doctor will diagnose the condition after discussing symptoms and risk factors and examining the foot and ankle. Diagnostic tests such as X-ray, MRI scan or bone scan may be required to confirm the fracture.


Stress fractures can usually be treated without surgery. This approach includes rest and limiting the physical activities that involves foot and ankle. Re-injury can occur if the stress fracture does not completely heal before resuming the activities.

Protective footwear may be recommended which helps 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 keep weight off the foot until the stress fracture is healed completely.

Surgery may be required if the fracture is not healed completely by non-surgical treatment. Your doctor makes an incision on the foot and uses internal fixation such as wires, pins, or plates to attach the broken bones of the foot together until healing happens. Some of the following measures may help to prevent stress fractures:

  • Ensure you start any new sport activity slowly and progress gradually
  • Cross-training: Using more than one training modality can help prevent overuse injuries like stress fractures. 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 repetitive stress on the bones of the foot.
  • 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 and avoid using old or worn out shoes
  • If your child complains of persistent pain and swelling, then stop the activities and make sure that your child rests for few days