Condition Spotlight: Stress Fractures

What are stress fractures?

Stress fractures are small, incomplete cracks that develop in a bone due to repetitive activity of overuse. The commonly affect lower extremities, like your feet.

There are many opportunities for stress fractures in your feet as there are 26 bones in them, and some are more susceptible to stress fractures than others. The weight bearing bones of your feet are under significant pressure each day.

The long bones of the foot, known as the metatarsals, along with the navicular bone are the most common sites of stress fractures.

What do stress fractures feel like?

Those who are suffering from a stress fracture will often describe a dull aching pain that increases with activity and is still present when they are resting.

Bruising and swelling at the site of the stress fracture can also be present.

Typically, the pain will have what is called an insidious onset, meaning that the pain will be minimal to begin with and will gradually increase as time goes on.

The pain is generally localised to the stress fracture site, however some patients will describe pain in other parts of the foot as they try to compensate or walk differently to offload the original pain.

Who do stress fractures affect?

Stress fractures develop over time and are common in those who participate in physical activity.

Activities that are high impact, like sports such as netball, basketball, football, dancing, athletics and so on, are more susceptible to stress fractures due to the repetitive nature of the movements involved.

Those who do a lot of walking are also at risk.

Sometimes, they can occur after a change in activity, whether that be a change in the type, frequency or duration of the activity.

Poor training or walking surfaces can also cause stress fractures.

People with weakened bones, such as those with osteoporosis or osteopenia are also at risk, as well as those who have sustained a fracture in that location in the past.

How are stress fractures diagnosed?

As podiatrists, we perform a thorough assessment to identify the cause of your pain.

During an assessment, we will palpate/press along the painful area and if we find a particularly painful and localised spot on one of the bones, we will suspect a stress fracture.

If this is the case, we will often send for scans such as an X-ray, MRI or CT scan to confirm this.

How are stress fractures treated?

It is very important that lower extremity stress fractures are managed properly in the first instance to prevent stress fractures turning into a further injury.

Bone typically takes around 6-8 weeks to heal completely, therefore there is no quick fix unfortunately.

There are a number of treatment options available for when the injury occurs, through to getting you back to activity or sport. These can include:

  • The use of a moon boot/CAM walker

Moon boots are designed to redistribute pressure away from the foot to offload the affected area.

They use a graduated pressure system that transfers the pressure up the leg towards the knee.

They also include a rocker bottom sole which helps to propel you forward with each step, without the need to flex your toes.

They can be a little heavy and require some getting used to, so we often recommend using crutches particularly for the first few days if you are feeling unsteady on your feet.

Moon boots will also enable you to walk pain free whilst the stress fracture is healing. If you continue to walk without adequate support, it may increase your pain!

Patients typically spend 6-8 weeks in a moon boot to ensure that the bone has adequate time to heal and recover.

  • Orthotics to help redistribute pressure

Orthotics are often used once you come out of the moon boot.

If our assessments have shown that the way you walk or run may have contributed to the formation of a stress fracture, orthotic therapy will help to redistribute the pressure evenly throughout the feet in order to reduce loading on particular spots.

  • Footwear modifications

There are particular footwear features that we recommend you look out for when looking for your new pair of runners. This is because poor footwear is often a contributing factor for stress fractures.

You can learn more about why the right footwear matters and how to pick it here.

  • A strengthening program to get you back to activity.

When you have spent a substantial amount of time in a moon boot, we expect that the muscles in your lower leg and feet which likely undergo atrophy, meaning that they can weaken and you can lose muscle bulk.

The aim of a strengthening program is to not only increase the strength of the muscles in the lower leg, but to also increase the strength of your feet.

Some exercises that may help include exercises such as the use of a theraband, balance and sport specific exercises and advice on general strength and conditioning.

Do you have a stress fracture?

If any of what we’ve described today sounds familiar to you, you might have a stress fracture. If you’re experiencing any pain or discomfort in your feet or lower limbs it’s best to book in with a podiatrist who can help assess, diagnose and treat your pain.

Our team of podiatrists here at Watsonia Podiatry are experts when it comes to all things feet, so if you’re in the North Eastern suburbs of Melbourne, book in to see us today!

Make an appointment by calling us on (03) 9432 2689 or book an appointment online.


Aaron Dri