Causes and Prevention of Stress Fractures in the Foot and Ankle

by Eli Reece

Causes and Prevention of Stress Fractures in the Foot and Ankle

Stress.

I’m sure that word has been included in all of our daily used vocabulary during these incredibly, well, for lack of a better word, stressful times. However, stress isn’t solely a pressure put on our mental health from life’s rollercoaster of events.

Our bones can be put under unnecessarily high levels of stress from overuse and repetitive activity, leading to small cracks called stress fractures. This unfortunate reality is especially true for the bones within our feet and ankles that we heavily rely on every single day.

“The foot and ankle are extremely vulnerable to stress fractures,” explains Gautham Gondi, MD, a foot and ankle surgery specialist. “The foot and ankle consist of weight-bearing bones that absorb the repetitive force of activities we do every day such as walking, running. and jumping.”

What exactly is a stress fracture?

A stress fracture is an overuse injury that often occurs in the following areas of the foot and ankle:

  • Second and third metatarsal: the long bones of your feet that connect the ankle to the toes.
  • Fibula: the outside bone of the leg.
  • Talus: the small bone that sits in between the heel and leg bones.

Extremely common in runners and athletes who participate in running sports like soccer or basketball, stress fractures develop over time as the result of repetitive force being placed upon the bone. The repetitive force is repeated so frequently that our bones and surrounding muscles do not have adequate time to heal.

The force isn’t quite strong enough to cause an acute fracture such as a broken ankle, but it does cause microscopic damage to the bone.  As Peter White, MD, who also specializes in foot and ankle surgery, states, “Our bones are in a constant state of developing new bone to replace older bone called remodeling. If our activity levels are too high on a specific bone area such as the foot or ankle, the breakdown of older bone accelerates. Therefore, our body’s ability to repair and replace it can’t catch up. The bone then weakens and is highly vulnerable to stress fractures.”

What causes a stress fracture?

Increase in physical activity

  • Most common cause is an abrupt increase in physical activity levels.
  • Can be frequency (i.e. number of days you work out in a week) or duration/intensity of workouts (i.e. training for an hour rather than training for 30 minutes).
  • Not pacing yourself when beginning a new workout routine, especially if you are not already in shape.
  • Combination of increasing activity, pushing through discomfort, and not giving your body ample time to rest often leads to stress fractures.

Poor technique

  • Altering the mechanics of how your foot absorbs the force of your foot hitting the ground can increase you risk for a stress fracture.
  • Blisters, bunions, tendonitis can cause you to shift your weight onto an area of your foot not made for force absorption.
  • An area of bone in the foot may be forced to handle more weight and pressure than usual.

Improper equipment

  • Shoes that are worn and flimsy lose their shock absorption capabilities.
  • Wearing them while walking, working out, or running can increase your risk for a stress fracture.
  • Running shoes have a 300 mile lifespan and should not be older than 3 months.

Change in surface

  • A change to a harder surface than you typically exercise on can raise the chances of you developing stress fractures.
  • Examples of these changes are moving from running on a treadmill to running on pavement, playing basketball on a hardwood floor to playing on a concrete court, and playing tennis on a grass court to playing on a hard court.

What is the treatment for a stress fracture?

Non-surgical treatment

  • Rest, ice, compression, and elevation known as the RICE protocol combined with over-the-counter ant-inflammatory medication can significantly reduce symptoms.
  • Your doctor may recommend using crutches to keep weight off the foot and/or ankle.
  • Your doctor might also recommend wearing protective footwear such as a walking boot.
  • Stress fractures typically take 4-6 weeks to heal. You must modify your activities during that time. For exercise, swimming and cycling are excellent alternatives.

If the above treatments are not enough, surgical treatment may be required for the bone to heal. Performing a procedure called internal fixation, your doctor will support the foot or ankle using pins, screws, and/or plates.

How can I prevent stress fractures?

  • Whether you are just beginning to work out or are just changing to a new type of workout, start the new activity slowly. Pace yourself.
  • Use proper equipment. Remember that shoes have a lifespan of 300 miles and should not be older than 3 months. Write on the heel of the shoe in sharpie the date you purchased them.
  • Cross train. Change up your workout routine to avoid over stressing one specific area of the body. For example, do cardio one day; do upper body the next; do core strengthening the next; etc.
  • Stop activity if pain or swelling returns to your foot and ankle.
  • Eat a balanced and healthy diet that contains plenty of calcium and vitamin D to support bone strength.

When thinking about what might have caused a stress fracture in our foot or ankle, many of us only attribute exercise as the culprit. Yet, as foot and ankle specialist Paul Switaj, MD, states, “Every daily step counts too. You must remember that walking to and from the kitchen or up and down the stairs numerous times a day adds up and places stress on the bones of your feet and ankles.”

With many of us working from home, it is likely that we are walking barefoot on hardwood floors for extended periods of time. So, while it might feel as though our activity levels are not as high when we are confined to our homes, the stress levels placed on our bodies still remain. Therefore, we must keep these prevention methods in mind when exercising and during the daily routines of our lives.