Stress Fracture Foot

A stress fracture is described as an overload in the bone which occurs in response to overuse or repetitive activities. In the foot, the most commonly impacted bones are the navicular and 5th metatarsal, though they can occur in any bone that is rapidly loaded. The navicular is the bone that connects the ankle joint to the inside of the foot and is subject to high compressive forces with foot strike during running and jumping, and the 5th metatarsal bone is one of the long bones in the middle-outside of the foot. Most often we see stress fractures, or their precursor the Stress Reaction, as result of repetitive exercise or loading, such as with long distance running or repeated jumping activities.

Symptoms of a stress fracture usually start off as vague pain over the area of overload. The pain generally increases with activity and settles with rest, but without proper diagnosis and treatment the pain can quickly increase causing limping, pain with all loading (walking) and interruption to sleep.

To assess for a stress fracture your Physiotherapist will do a full assessment of your lower limb considering a wide range of factors including; referred pain from the low back, the mechanics of the whole lower limb and foot, strength and balance of the muscles surrounding the ankle, sporting technique, motor control, footwear, and biomechanics. Often stress fractures occur not only due to an increase in force, but a failure to adequately dissipate them. As such, your physiotherapist will assess your whole lower limb looking for areas of stiffness, weakness, or instability, which may cause forces to compound (ankle range of motion, weak glutes, knees rolling in etc) and contribute to the overload. Most notably, your physiotherapist will do a very specific assessment of the painful area. Stress fractures in the feet often have a very specific area of pain (smaller than a 10-20c piece) and require an expert in anatomy to assess this to exclude other things like joint pain or stiffness.

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