Stress Fracture In Foot: What You Should Know

A stress fracture is a crack within a bone. Unlike other fractures that occur when there is an external force, an “internal” force causes a stress fracture.

The fracture happens when the bones are stressed and overworked just like how we get stressed from too much work.

The bones usually affected are the weight-bearing bones of the body, which are the bones in the legs. These bones are:

  • The Shin
  • The Ankle
  • The heel
  • The metatarsals (bones in the foot)
  • The femur
  • The hip (occasionally)


How Does It Happen?

There is a constant activity that happens in our bones. This is because our bones undergo stress or loads such as walking, jumping or running. Bones are being absorbed and recreated constantly to meet up with the load or stress applied to them. This process is called the remodelling or repair process.

The cells responsible for creating bones are called Osteoblasts while the cells responsible for destroying and absorbing bones are called Osteoclasts.


During the remodeling or repair process, the osteoblasts and osteoclasts need to work in perfect harmony to maintain the bone.

When a lot of load or stress is placed on the bone, the osteoclast absorbs the bone and the osteoblasts are to rebuild the bones. However, if the stress is so much, it can make the osteoclasts work faster than the osteoblasts, which make the bones weak and can result to a crack within the bone, which is known as STRESS FRACTURE.

What Can Cause Stress Fracture in Foot?

1. Weak Muscles

The stress placed on the bones is usually shared between the muscles and the bones. If, however, your muscles are weak, there is no even share of stress between the bones and muscles. This increases the stress placed on the bones and can then lead to a stress fracture.

2. Osteoporosis

It is also known as a porous bone. This is a condition in which there is reduced bone density. This reduced bone density can happen if the osteoblasts are working slower than the osteoclasts.

A normal bone looks like a honeycomb but a porous bone has larger holes. This makes the bone weak and prone to any form of fracture, especially stress fracture.

3. Low Vitamin D

Vitamin D plays a major role in bone health. It enables our body to properly absorb calcium from our foods, which is necessary for our bone health.

Without vitamin D, our bodies cannot absorb calcium, which is necessary for the remodeling process. This can lead to a stress fracture.

4. Improper Footwear

The bones in the legs especially the foot receive a lot of shock from the ground. Shoes are meant to help reduce the shock received by the feet when we do activities such as walking, running or jumping.

Wearing improper shoes for these activities increases the shock or stress received by the foot. This puts a lot of stress on the bones in the foot and then lead to stress fracture.

5. Foot Deformities

Foot deformities are caused by irregular bone formation. Deformities such as a high arch or flat foot already put a lot of stress on bones and muscles and may lead to stress fracture.


6. Not Warming Up Properly

The muscles and bones work together to evenly share stress received by the body. A warm-up prepares the bones and muscles to take up any stress that may be coming their way.

Not preparing your muscles and bones for an exercise routine can cause a stress fracture.

7. Over-exercising

Overdoing what your body is not normally used to or over pushing yourself to do more can cause more harm than good.

Let’s assume I can do 10 burpees and I decide to work out with my friend or I am not seeing the benefits of the exercise, I might force myself to do more like 20 or 30.

If I continue to do this, I am unconsciously putting my bones under a lot of stress, which can eventually lead to a stress fracture.

8. Sedentary Lifestyle

If all you do is sit and the only time you move around is to eat or use the toilet or go into your car, then you are at a risk of having a stress fracture. Why?

For the remodeling process to work, the load has to be placed on the bones. Also during the remodeling process, calcium is placed at the bone site, which strengthens the bone.

When you are sedentary, the bones are not undergoing any normal stress, which reduces the calcium that is necessary for the bones and leads to a stress fracture.

What Are The Symptoms And Signs?

1. Pain During Normal Activities

If you feel pain after exercising and during your daily activities, it is a likely sign that it may be a stress fracture.

2. Swelling

Like all other fractures, swelling at the fractures site is also a sign of a stress fracture.

3. Tenderness

Touching the area of pain can be tender.

How Is It Treated?

1. Medications 

See a doctor before taking any medications. Medications like ibuprofen or paracetamol may be prescribed for the pain. Calcium tablets may also be prescribed to improve bone health.

2. PRICE line of treatment.

P- Protect

Protect the affected part of the body from any activity. This can be done by wearing a protective footwear or ankle brace if necessary.

R- Rest

Like every other injury, avoid bearing weight on the affected leg. Let the injury heal. Walking aids like crutches may be recommended to enable you to rest the affected part.

I – Ice

Ice helps to reduce swelling and also relieve pain. An ice pack can be placed on the affected part for 15 – 20 minutes every 4 hours.

C – Compression

A bandage can be used to reduce swelling at the affected part and also provide a means of support.

E – Elevation

Elevate the affected part above heart level to help reduce the swelling at the affected area.

See A Doctor

I will advise that a doctor sees the affected area as other conditions can mimic a stress fracture. You may be asked to also see a physiotherapist during rehabilitation. You may be prescribed some kind of support and walking aid depending on the kind of injury and other factors.

The Physiotherapist will also help in drawing up exercises you can do while waiting for the fracture to heal. this exercises can be isometric contractions that do not involve movement at the joints. This will strengthen the muscle and prevent unnecessary stress on the bones.

If the broken bone is not aligned properly, doctors may try to reduce it manually or surgically and place a brace or cast to keep the broken edges in place for healing to occur.

How Do You Prevent It?

1. Wear appropriate shoes

Always exercise with appropriate shoes.  An appropriate shoe should have some of the following features:

  • There must be a soft and stable heel support to prevent unnecessary movement of the heel
  • The heel or sole of the shoe must not be too flat. Heel height should not exceed 1 inch (2.5 cm).
  • Shoes have expiry dates. Check your shoes regularly. If your shoes are not providing the support they were given initially, then it is time for them to be replaced. IF not, they can cause injury to the foot or ankle.
  • There must be an arch support. For someone with a high arch, the arch needs to be supported to avoid extra stress on the arch. Also, it helps reduce the stress on the arch of the foot.
  • The shoes should be light and not tight.

2. Listen to your body

When you start feeling pain, stop the activity you are doing. Pain is a language your body uses to communicate with you. Once you feel pain, you know there is something wrong. 

3. Be Active

Move around. Reduce your sitting time. Do exercises within your pace.

4. Warm Up Properly

Warm up and stretch properly before and after every exercise so that your muscles and bones are prepared to take on the stress.

5. Alternate your exercises

Do not concentrate on just your legs. alternate your exercises. you can do two leg exercises, 2 exercises for your core, some exercises for your back and arms. This helps reduce the load you place on various parts of your bones and muscles.

6. Take food rich in calcium and vitamin D

Eat food rich in calcium and Vitamin D as they are necessary for a good bone health. Foods rich in Vitamin D and Calcium are fish, liver, eggs, milk, vegetables, beans and okra to mention a few.

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Adekanmi Lipede, M.Sc, MPH

Adekanmi Lipede is a licensed physiotherapist with a Master's degree in physical activity and public health from Loughborough University. She joined 25 Doctors in 2018 and is passionate about educating people about the best steps to take when trying to be physically fit or when recovering from a mobility-related condition. For fun, she loves to exercise and read.
Adekanmi Lipede, M.Sc, MPH