Stress Fractures in Your Feet and Ankles
The weather is nice again and you are ready to get fit in the sunshine. The only problem is you have been hibernating for the last 5 months and your body doesn’t know you are about to give it an enormous shock. If you are starting a new exercise routine, it is best to start slow. Often, your muscles and joints are tighter, and this tightness can lead to injuries.
Stress fractures are a common injury among those new to the exercise world and also to seasoned athletes. Fractures in your feet and ankles can severely impact your quality of life. After all, we use our feet all day without really thinking about it. Generally speaking, repetitive task and overuse causes stress fractures. Impact plays big role in foot and ankle stress fractures. Also, these locations are one of the most affected areas by stress fractures.
Below I will highlight:
- What is a stress fracture?
- Activities that lead to a stress fracture
- How to avoid stress fractures
- How to treat stress fractures
- When you need to seek professional treatment
What is a stress fracture?
Stress fractures are categorized as overuse injuries. They are rarely because of a powerful impact or catastrophic injury. A stress fracture is a hairline crack in a bone. Severe bruising on a bone may also classified as a stress injury, called a stress reaction. Often, the pain comes on gradually. Weight-bearing activities will increase the pain as well as when the area is touched.
Our feet and ankles are under constant stress throughout the day as you walk, stand, run, and jump. Because of this, the most common place to experience a stress fracture is in the lower leg and foot.
The most injured spots are:
- Metatarsal Bones (in the middle of your foot)
- Fibula (part of your shin)
- Calcaneus (the heel bone)
- Talus (that’s in the ankle)
- Sesamoids (Near your big toe)
- Navicular (top of your foot)
Let’s deep dive into the metatarsal and talus stress fractures.
Stress Fracture in Your Metatarsal Bones
The metatarsals are the middle foot bones, with one associated with each toe. They are long and thin. Because they take the greatest impact when you are on the move, they are the most common location for a stress fracture. These kinds of stress fracture typically present as general pain in the middle of the foot that is made worse by weight-bearing exercise.
Some issues come into play with the metatarsals towards the outside of the foot (particularly the fifth). The blood supply is weak to that part and can cause issues with healing.
Stress Fracture in Your Ankle (Talus)
The bones in our ankle are under almost constant movement and dependent on your activity level, under considerable stress. The talus is another location that is afflicted by stress fractures. The issue typically presents with pain deep inside the ankle joint and increases over time. It is possible for the pain to become so severe, you cannot continue your activities. This can happen quickly. Because of the location of the talus, you may also feel issues with weakness, stiffness, and walking correctly.
What activities lead to stress fractures?
A change in activity causes most stress fractures. This can be a new activity in your life or an increase in intensity of your workout. Even activities as simple as walking can lead to stress fractures if your body is not used it.
High-level athletes also experience stress fractures from overuse. Those who take part in ballet, soccer, basketball, and running are at high-risk for stress fractures.
This is where shoes come into play! Stress fractures may occur from a misalignment of your joints when performing activities or a bad weight distribution across your feet. Incorrect footwear will shift your center of gravity in different directions, and this increases stress on parts of the foot and ankle that are unnatural. Properly fitting footwear is mandatory when performing high-impact activities.
How do I avoid a stress fracture in my feet and ankles?
If you are getting ready to start an exercise regimen or are ready to up your game, then the best way to avoid a stress fracture is to phase it in slowly. Do not make changes overnight. How you taper your exercise really depends on your current level. You will need to make slight changes over time so you can properly challenge your body while not overloading it.
If you are a high-level athlete, the risk of stress fracture is high. Likely by the time you are an adult, you have made the same repetitive motions in your sport for years. Avoiding stress fractures in this situation heavily involves rest, proper form and weight distribution, and proper footwear.
Ultimately, listen to your body. Exercising is not supposed to be painful. This does not mean that you cannot push yourself to try harder, but if you feel pain, it is best to stop that activity (at least for the day). You can try again the next time you exercise. If the pain is still present, consider some rest or a non-impact exercise like swimming for a few days. Stress fractures are difficult to heal and the best way to take care of your body is to never have them.
What about osteoporosis and vitamin D?
While osteoporosis affects both men and women, women are at a significantly higher risk because of their body chemistry. The hormones that allow us to bear children also like to weaken our bones. With this in mind, women are more prone to stress fractures. Osteoporosis is a major threat and causes your body to fracture faster than others.
A secondary issue cause of osteoporosis and stress fractures is vitamin D deficiency. Vitamin D deficiency is very common in the northern states because of the long and cold winter months. Our bodies need vitamin D to properly process calcium. As we all know when we were little and told to drink our milk, calcium is vital to strong bones and teeth. Therefore, vitamin D deficiency leads to weaker bones and that in turn leads to a higher chance of stress fractures. Ultimately, there are only two ways to gain vitamin D: active sun exposure and supplements. You will benefit greatly from regular vitamin D checks which are performed with a simple blood test. You should have these checks once before winter and once before summer to ensure proper levels.
When should I see a doctor for my stress fracture?
Continuing to perform activities on a stress fracture will certainly prohibit it from healing. Not only are fractures incredibly painful, they can take up to 12 weeks to heal. If notice pain with weight bearing, pain to touch over a focal area, and swelling then see your doctor immediately. Your doctor can rule out other types of fractures as well. Until you can see a doctor, stop the activity that is bringing you pain.
She will take x-rays to get a better look at the structure of your feet and ankles. She will apply pressure in any areas you are experiencing tenderness. Stress fracture pain is characteristically very pinpointed.
In some cases, an X-ray may be negative initially and the fracture may not show up for weeks after the start of your pain. In these cases, I still treat these injuries as stress related injuries. An MRI will usually be diagnostic in these cases.
How do I treat a stress fracture in my foot or ankle?
The first suggestion from your doctor will be to take a break from the activity causing you pain. If that is not possible, she will look at modifying your activities to remove stress from your injured area. Stress fractures can take up to 12 weeks to heal remember, but will take even longer if we push them to full fractures.
With a minor stress fracture, rest and immobilization are enough to heal. Shoes with a stiff sole to prevent movement greatly aids in the healing of a stress fracture in the foot. You may need a walking boot for a stress fracture in the ankle joint or fibula.
With more serious injuries, full immobilization will be necessary for your stress fracture to heal. Your doctor may rarely even cast your foot or ankle to ensure full immobilization.
Some severe stress fractures will not heal from rest and immobilization alone, and rarely surgery may be necessary.
Overall, stress fractures are serious business that you need to be wary of. Proper footwear and proper form are vital to keeping your whole body happy and healthy. If you are looking to start a new exercise regimen with the spring weather, start out slow and listen to your body.
Hope this helps!
XOXOXO
Dr. Eva
