The Foot Stress Fracture Test: Causes, Symptoms + Treatment

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A stress fracture in your foot is one of the most problematic injuries a runner can face. Although it may not necessarily last as long as other injuries, such as Plantar FasciitisITB Syndrome, or Runner’s Knee, it is still a serious injury that needs to be addressed.

There are many reasons why a foot stress fracture can occur, usually when your training demands exceed your body’s training tolerance.

Runners engage in repetitive, high-impact activities. Repetitive loading and inadequate rest can lead to the accumulation of micro-damage in the bones. If left completely untreated, it can lead to a complete break.

In this article, we will provide up-to-date science regarding a foot stress fracture, discuss the nuance involved in this pathology and look at a foot stress fracture test and how to effectively treat this problematic injury.

More specifically, we will cover the following:

  • What Is A Stress Fracture?
  • Foot Stress Fracture Test: Diagnosis
  • Stress Fracture Symptoms
  • The 6 Most Common Causes Of A Stress Fracture In Foot
  • Stress Fracture Treatment
  • Foot Stress Fracture: Summary

Let’s jump into it!

A person holding their foot which may have a stress fracture.

What is a stress fracture?

A stress fracture in the foot refers to a small crack or hairline fracture that typically develops in a bone due to repeated excessive force on the foot.

They usually occur through repetition rather than a single event, like a fall.

Stress fractures typically occur in weight-bearing bones, which is why the foot is such a common area to experience them.

It is often seen specifically in the second and third metatarsals (bones in the forefoot) or the calcaneus (heel bone), but it can also affect other bones in the foot.

Over 80% of stress fractures are found in the lower extremities.

The repeated stress and impact placed on the foot during activities like running or jumping can overwhelm the bone’s ability to repair and remodel itself adequately.

A runner holding their foot in pain.

Foot stress fracture test: Diagnosis

So what does a stress fracture feel like?

In order to get a proper diagnosis of a stress fracture, you will need to get a full medical history assessment, physical examination, and imaging studies.

A medical doctor will use an X-ray, CT, MRI, or DEXA scan to confirm a foot stress fracture test. While X-rays may not initially reveal the fracture, more sensitive tests like MRIs or bone scans can detect early-stage stress fractures.

A medical history will enquire about the onset, duration, and nature of the symptoms, alongside a physical examination that will assess for localized tenderness, swelling, and changes in the foot alignment.

It is essential to seek medical attention if a stress fracture is suspected, as proper diagnosis and treatment are crucial for effective recovery and to prevent complications.

A person holding their foot.

Stress Fracture Symptoms

The level and severity of symptoms that you experience will depend on whether you are suffering from a mild or severe stress fracture.

So, what does a stress fracture feel like?

  1. Gradual onset of pain: Stress fractures in runners often exhibit a gradual onset of pain, starting as mild discomfort and progressively worsening with continued activity. The pain tends to subside or improve with rest.
  2. Localized pain and tenderness: Runners with stress fractures experience pain concentrated in specific areas of the foot, such as the metatarsals (bones in the forefoot) or the heel. Tenderness is typically felt upon touch or pressure over the affected bone.
  3. Swelling: Swelling is a common occurrence around the site of the stress fracture. It is often accompanied by mild to moderate inflammation in the affected area.
  4. Pain with weight-bearing: Activities that involve weight-bearing, including walking or running, tend to exacerbate the pain associated with stress fractures. The impact and repetitive stress placed on the foot during these activities intensify the discomfort.
  5. Pain at night/when resting: Some runners may notice increased pain or discomfort at night or during periods of inactivity. This can be attributed to the body’s attempt to heal the stress fracture when not engaged in weight-bearing activities.
A person running.

The 6 Most Common Causes of A Stress Fracture in Foot

#1: Overuse

Overuse stands as the primary etiological factor in a foot stress fracture, which commonly manifests among runners.

The repetitive force, which manifests when running, causes microscopic damage to the bone.

Over time the bone will adapt to the stimulus, strengthening and increasing its capacity to manage the load.

However, if the bones in your feet are not given enough time to recover, stress will compound, possibly resulting in a stress fracture.

Overusing the body, relative to its capacity, is an easy thing to do. Overuse injuries account for up to 80% of all running injuries.

It’s easy to catch the running bug, getting swept up in the feeling of physical wellness and endorphins. It can be difficult to reign in the effort, retain a sense of perspective, and allow our bodies a nourishing environment to adapt to the required load volume.

Suddenly increasing running volume, intensity, or frequency are all common causes of overtraining syndrome.

The human body possesses remarkable potential, provided that it receives an appropriate balance of stimuli, rest, and nourishment.

It is imperative to emphasize the significance of regularly running at a low to moderate intensity and maintaining a consistent training routine.

Assessing the intensity of running sessions can be achieved through methods such as the rate of perceived exertion (RPE) or utilizing a heart rate monitor.

People running.

#2: Running Form

How we run is thought to have an impact on the rates of stress fractures. However, there is little definitive evidence to support this.

There seems to be a relationship between tibial stress fractures and individuals who overstride with a clear heel strike.

Overstriding is also likely to impose greater stress on the hip, elevating the potential for femoral stress fractures.

So should I run with a forefoot strike? Maybe… but make the change slowly.

Running with a forefoot strike will inevitably increase the load put upon the foot and ankle, consequently raising the risk of stress fractures in these areas.

Rapidly transitioning to more minimal footwear or embracing a forefoot strike technique can significantly increase the likelihood of sustaining a metatarsal stress fracture.

As mentioned above, the key is to make changes gradually, allowing the body time to adapt.

A cut out sun with the words vitamin d in the middle.

#3: Nutrition

An insufficient diet, lacking in vitamins and minerals, can put you at risk for stress fractures.

Insufficient levels of specific vitamins can have severe consequences for the body.

Vitamin D is an essential, fat-soluble nutrient that is a key modulator of bone health, and low levels of vitamin D may increase the risk of stress fractures. This is particularly true in active populations such as recreational runners.

Research has indicated a higher prevalence of stress fractures during the winter season, which can be attributed to decreased levels of vitamin D in the body. During winter months, when there are fewer sunlight hours, the need for supplementing vitamin D is even higher.

Adequate calcium intake is vital for maintaining overall health and supporting proper growth and development.

Chronically under-eating will impair the body’s ability to repair itself, leading to a higher risk of stress fractures.

A pair of old running shoes.

#4: Bone Density

Runners face an increased risk of stress fractures when certain conditions, such as osteoporosis, are present.

The hormonal fluctuations associated with the menstrual cycle make women who experience amenorrhea, or the absence of menstruation, due to inadequate caloric intake in their diet, significantly more susceptible to stress fractures.

#5: Change in Surface

If you’re a regular trail runner who suddenly signs up for a road marathon, or vice versa, and you don’t gently introduce your body to the new surface, you may be at higher risk for a stress fracture.

#6: Old Shoes

Wearing worn-out shoes that don’t fit you well can lead to inadequate cushioning and support, which can increase the stress on the bones.

A physical therapist massaging a foot.

Stress fracture treatment

Although stress fractures can be painful and stubborn, they usually heal without too many curveballs.

Which specific blueprint of rehabilitation is right for you will depend on what caused the stress fracture in the first place. As such, you should seek the guidance of a medical professional to ensure you are getting the right treatment.

Treatment for a stress fracture will involve:

Physical Therapy:

A program of gradual strengthening stretching exercises prescribed by a physical therapist can help increase the strength of the supporting muscles and bone density.

Over time you should look to improve foot and leg strength and enhance flexibility to prevent future injuries.

A foot boot.

Rest and Immobilization:

In the early stages, the primary treatment for stress fractures will involve reducing weight-bearing activities and providing sufficient time for the bone to heal.

Doctors will usually prescribe the use of crutches or a walking boot to offload the affected foot and promote healing.

Nutrition and Supplementation:

If it was deemed clinically appropriate, then ensuring adequate intake of calcium, vitamin D, and other essential nutrients will help heal and prevent any future injuries.

In some cases, the use of supplementation may be recommended, especially if there are known deficiencies.

Activity Modification

If you have a stress fracture, you have to stop running.

Temporarily avoid high-impact activities and gradually return to running under the guidance of a healthcare professional.

That said, if you are able to participate in crosstraining, you will be able to maintain a degree of cardiovascular and muscular strength.

Vascularization around the area will also promote healing.

A person swimming.

Foot stress Fracture: Summary

If you have a stress fracture, proper diagnosis and treatment are crucial for effective recovery and to prevent complications.

Do not ignore the symptoms and continue participating in running, as this can lead to a more severe fracture, potentially prolonging the recovery process.

If you want to know how to strengthen the lower body and reduce your injury risk, check out:

Photo of author
Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist. Evenly splitting his time between trail running, road biking, and MTB.

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