Stress Fracture of the Foot
(Also known as Foot Stress Fractures)
What is a stress fracture of the foot?
A stress fracture of the foot is a condition characterized by an incomplete crack in one of the foot bones.
The foot comprises of many small bones 7 of which are located in the rear foot and are collectively known as the tarsals. The mid foot comprises of 5 long bones known as the metatarsals. The toes each comprise of several small bones known as the phalanges (figure 1). Each bone within the foot forms joints with adjacent bones.
The bones of the foot provide attachment points for many muscles of the lower leg and foot. When these muscles contract, a pulling force is exerted on the respective bone. In addition, weight bearing activity places stress on the bones of the foot. When these forces are excessive or too repetitive, and beyond what the bones of the foot can withstand, bony damage can gradually occur. This may initially result in a bony stress reaction, however, with continued damage may progress to a stress fracture of the foot.
Cause of a stress fracture of the foot
A stress fracture of the foot typically occurs over time with excessive weight bearing activity such as distance running, sprinting, jumping or dancing or occasionally, excessive walking. They often occur following a recent increase in activity or change in training conditions (such as surface, footwear or technique changes etc). A stress fracture of the foot may sometimes occur traumatically such as during a landing onto a hard surface from a height. In patients with weakened bone due to conditions such as osteoporosis, normal everyday weightbearing forces may be sufficient to cause a foot stress fracture.
Signs and symptoms of a stress fracture of the foot
Patients with this condition typically experience a localized pain in the foot, toes or ankle that corresponds with the affected bone. Symptoms often increase with weight bearing or impact activity (such as running, jumping, sprinting, hopping, lifting or carrying) particularly on hard, or uneven surfaces, up or down hills or stairs or in combination with twisting forces. Symptoms may also decrease with rest. As symptoms worsen, the patient may limp during weight bearing activity and may have to stop activity due to pain.
Occasionally, pain may radiate to other areas of the foot that are not specifically involved in the injury. In more severe cases, walking or standing may be enough to aggravate symptoms. Other symptoms may include night ache, swelling or pain on firmly touching the affected bone.
Diagnosis of a stress fracture of the foot
A thorough subjective and objective examination from a physiotherapist may be sufficient to form a clinical diagnosis of a foot stress fracture. Further investigations such as an X-ray, MRI, CT scan or bone scan are usually required to confirm diagnosis and determine the severity of injury.
Prognosis of a stress fracture of the foot
With appropriate physiotherapy management, most patients with a stress fracture of the foot can make a full recovery (return to sport or full activities) in a period of 3 – 9 months. In more severe cases, recovery may take 1 year, or longer, depending on the intervention required and a range of other factors. In rare cases, some patients may experience ongoing symptoms or complications which may require further management.
Treatment for a stress fracture of the foot
Contributing factors to the development of a stress fracture of the foot
There are several factors which may contribute to the development of a foot stress fracture. These need to be assessed and corrected with direction from the treating physiotherapist. Some of these factors include:
- inappropriate or excessive training or activity (particularly on hard or uneven surfaces)
- inadequate recovery periods from training or activity
- poor foot posture (especially flat feet or high arches)
- poor biomechanics
- muscle weakness (particularly of the gluteals, quadriceps, calf and core stabilisers)
- muscle fatigue
- poor balance
- poor flexibility (particularly of the calf muscles)
- joint stiffness (particularly of the ankle, heel or foot)
- inappropriate footwear
- poor running technique
- inadequate diet
- leg length discrepancies
- being overweight
- menstrual disturbances
- poor bone density (i.e. osteoporosis or osteopenia)
Physiotherapy for a stress fracture of the foot
Physiotherapy treatment for patients with this condition is vital to hasten healing, prevent injury recurrence and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- joint mobilization
- joint manipulation
- electrotherapy (e.g. ultrasound)
- dry needling
- the use of crutches
- the use of a protective boot or brace
- activity modification advice
- foot taping
- biomechanical correction (e.g. the use of orthotics)
- technique correction
- footwear advice
- exercises to improve strength, balance, flexibility and core stability
- a gradual return to running / activity plan
Other intervention for a stress fracture of the foot
Despite appropriate physiotherapy management, some patients with a stress fracture of the foot do not improve and require other intervention to ensure an optimal outcome. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization, use of crutches or protective boot, review with a podiatrist for possible orthotics or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the stress fracture of the foot. Occasionally, patients with this condition may require surgery to stabilize the stress fracture and aid healing.
Exercises for a stress fracture of the foot
The following exercises are commonly prescribed to patients with a stress fracture of the foot following the initial period of immobilisation. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 – 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms
Foot & Ankle Up & Down
Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 – 20 times provided there is no increase in symptoms.
Foot & Ankle In & Out
Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 – 20 times provided there is no increase in symptoms.
Foot and Ankle Circles
Move your foot and ankle in a circle as large as possible and comfortable without pain (figure 4). Repeat 10 – 20 times in both clockwise and anticlockwise directions provided there is no increase in symptoms.
Rehabilitation Guide for a stress fracture of the foot
Find a Physio
Find a physiotherapist in your local area who can treat a foot stress fracture.
Physiotherapy products for a stress fracture of the foot
Some commonly recommended products by physiotherapists for patients with this condition include:
To purchase physiotherapy products for a foot stress fracture click on one of the above links or visit the PhysioAdvisor Shop.
Other Useful Exercises
- Read about Correct Footwear for running.
- Read about How to use Crutches correctly.
- View Do I Need Orthotics?
- View a Return to Running Program
- Wondering Why is My Injury Not Improving?
- Read about when to use Ice or Heat
- View our Foot Diagnosis Guide.
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