Stress Fractures: The Hidden Cause of Persistent Foot Pain

If you’ve been dealing with a nagging ache in your foot that just won’t go away — especially after exercise or long periods on your feet — it might not be a simple sprain or sore muscle. It could be a stress fracture.

Unlike a sudden break caused by trauma, stress fractures develop slowly over time. They’re tiny cracks in the bone that often start as small injuries but can turn into major problems if left untreated.

At Restore Foot & Ankle Specialists, we often see patients who mistake stress fractures for minor foot pain — until the discomfort becomes unbearable. Here’s what you need to know about how they develop, the warning signs, and how to heal properly.

What Is a Stress Fracture?

A stress fracture is a small, hairline crack in a bone caused by repetitive stress or overuse rather than a single traumatic event. Think of it as your bone’s version of fatigue — too much pressure, too often, without enough time to recover.

In the foot and ankle, stress fractures commonly occur in the:

• Metatarsal bones (especially the second and third)

• Navicular bone (top of the midfoot)

• Calcaneus (heel bone)

• Tibia or fibula (lower leg bones near the ankle)

They’re especially common in athletes, runners, and people with active jobs that keep them on their feet all day.

What Causes Stress Fractures?

Stress fractures develop when repetitive force overwhelms the bone’s natural ability to repair itself.

Common Causes Include:

• Overuse and repetitive activity: Running, jumping, or long-distance walking without adequate rest.

• Sudden increases in training intensity or duration: Going too far, too fast.

• Improper footwear: Worn-out or unsupportive shoes that fail to absorb shock.

• Poor biomechanics: Flat feet, high arches, or gait imbalances that unevenly distribute weight.

• Bone weakness: Conditions like osteoporosis or vitamin D deficiency.

• Hard surfaces: Training or working on concrete or other unforgiving surfaces.

• Previous injuries: Prior fractures or sprains can make bones more susceptible.

Even non-athletes can develop stress fractures, especially if they spend long hours walking or standing in unsupportive shoes.

Common Symptoms of a Stress Fracture

The symptoms of a stress fracture often appear gradually and may be mistaken for a muscle or tendon issue.

You may have a stress fracture if you experience:

• Localized pain that worsens with activity and improves with rest

• Swelling or tenderness over a specific area of the foot

• Pain when pressing on the bone

• Bruising or mild redness (less common)

• Difficulty bearing weight or walking normally

Unlike an acute fracture, stress fractures typically don’t cause immediate severe pain — but they can worsen over time if ignored.

Why Stress Fractures Are Often Missed

Many people try to “push through” foot pain, assuming it’s just soreness or a minor sprain. But continuing activity on a stress fracture can cause the bone to fully break, leading to a longer recovery and more invasive treatment.

Because stress fractures often don’t show up on standard X-rays right away, early diagnosis requires the expertise of a podiatrist — and sometimes advanced imaging like MRI or bone scans.

How Podiatrists Diagnose Stress Fractures

At Restore Foot & Ankle Specialists, we use a combination of clinical evaluation and imaging to confirm stress fractures.

Your podiatrist will:

1. Assess your symptoms and activity level

2. Palpate (press on) the painful area to identify tenderness along the bone

3. Order X-rays to check for visible cracks or signs of healing

4. If needed, recommend MRI or bone scans for subtle or early fractures

Accurate diagnosis ensures proper treatment and helps prevent complications like delayed healing or chronic pain.

Treatment Options for Stress Fractures

Fortunately, most stress fractures heal without surgery — but they do require proper rest and protection.

1. Rest and Activity Modification

The most important step is to stop the activity that caused the injury. Continuing to walk, run, or train through pain will delay healing.

2. Immobilization

Your podiatrist may recommend wearing a CAM walker boot, stiff-soled shoe, or cast to reduce stress on the affected bone.

3. Crutches or Mobility Aids

For more severe pain, using crutches or a knee scooter helps keep weight off the injured foot.

4. Ice and Elevation

Applying ice packs and keeping your foot elevated reduces swelling and discomfort.

5. Pain Management

Over-the-counter anti-inflammatories (like ibuprofen) can help reduce pain and inflammation — but should be used as directed.

6. Gradual Return to Activity

Once healed, your podiatrist will design a rehabilitation plan to rebuild strength and flexibility. Returning to activity too soon can cause re-injury.

When Is Surgery Needed?

Surgery is rarely needed for stress fractures, but in severe or non-healing cases, your podiatrist may recommend internal fixation (using screws or plates) to stabilize the bone. This is more common in high-risk areas like the navicular or fifth metatarsal.

How to Prevent Stress Fractures

You can significantly lower your risk with a few smart habits:

• Wear supportive footwear designed for your activity type.

• Replace shoes regularly, especially if you’re active — worn-out soles lose shock absorption.

• Increase activity gradually, allowing your body to adapt.

• Cross-train with low-impact exercises like swimming or cycling.

• Maintain strong bones with adequate calcium, vitamin D, and resistance training.

• Use custom orthotics if you have flat feet, high arches, or gait imbalances.

• Listen to your body — pain is your body’s early warning sign.

The Bottom Line

Stress fractures may start small, but they can cause big problems if left untreated. Persistent foot or ankle pain — especially after activity — shouldn’t be ignored. Early diagnosis and treatment can make the difference between a few weeks of rest and months of recovery.

✅ At Restore Foot & Ankle Specialists, our podiatrists specialize in diagnosing and treating stress fractures and other overuse injuries. From digital imaging to custom orthotics and personalized rehabilitation plans, we’ll help you heal safely and get back to doing what you love — pain-free. Contact our office today with Dr. Gireesh Reddy or Dr. Sirisha Pokala by calling (469) 573-3427 or by booking an appointment online.