What is an Ankle or Foot Stress Fracture?
When a small crack, multiple cracks, or severe bruising occurs within a bone, it indicates a stress fracture. Stress fractures are caused by overuse. Unlike acute fractures that occur from a single traumatic event, stress fractures develop gradually over time. They are common in the weight-bearing bones of the foot and ankle. These injuries are more frequently seen in athletes, runners, dancers, and people who suddenly increase their activity levels.
Typical symptoms include localised pain that worsens with activity, tenderness to touch, and sometimes mild swelling. Early diagnosis and appropriate offloading are key to preventing the fracture from worsening and allowing a full recovery.
Access Ortho Fracture clinics in Brisbane and Ipswich offer rapid appointments for acute orthopaedic injuries such as stress fractures.
What are the Common Types of Foot and Ankle Stress Fractures?
Stress fractures commonly occur in bones of the foot and ankle that have a significant role in supporting body weight and absorbing impact during walking, running, and jumping. Stress fractures have different healing timelines and treatment needs depending on the cause, severity and which bone they occur in. The most frequently affected bones include:
1. Metatarsal Stress Fractures
The metatarsals are the long bones in the midfoot that connect the toes to the rest of the foot. Due to their position and role in weight-bearing, the second and third metatarsals are the most commonly affected. Pain is often localised to the top of the foot and worsens with activity.
- Common in: Runners, dancers, and people who increase their training too quickly.
- Treatment: Rest, activity modification, and in some cases, a moon boot or crutches for offloading.
2. Fifth Metatarsal Stress Fractures
The fifth metatarsal runs along the outer edge of the foot. Stress fractures here, particularly at the base (a “Jones fracture”), can have a higher risk of delayed healing or non-union.
- Common in: Sports involving cutting or pivoting movements.
- Treatment: Varies from boot immobilisation to surgical intervention depending on the location and severity.
- With conservative treatment – 60% don’t heal or re-fracture, 30% heal
- With Surgical treatment – 60-70% heal, 30% don’t heal or re-fracture
3. Navicular Stress Fractures
The navicular is a small bone on the top of the midfoot that helps distribute forces across the arch. Navicular stress fractures can be harder to diagnose and often present as vague midfoot pain.
- Common in: High-impact sports like basketball and track and field.
- Treatment: Strict offloading, often with a non-weight-bearing boot or cast, due to the risk of poor healing.
4. Calcaneal (Heel Bone) Stress Fractures
The calcaneus is the large bone forming the heel. Stress fractures here can cause deep, aching pain in the back or bottom of the heel, especially when walking or standing.
- Common in: Military recruits, hikers, and runners—often called “march fractures.”
- Treatment: Reduced weight-bearing, supportive footwear, or a boot. Full recovery can take several weeks.
5. Talus Stress Fractures
The talus is a bone within the ankle joint that transfers weight between the leg and foot. Stress fractures here are less common but can be serious.
- Common in: Athletes in sports with repeated jumping or impact.
- Treatment: Requires careful offloading and medical supervision due to the talus’s limited blood supply.
How Common are Foot and Ankle Stress Fractures?
Foot and ankle stress fractures are among the most common overuse injuries, accounting for nearly 50% of all stress fractures in the body. These fractures occur most frequently in bones that bear weight and absorb repetitive impact; hence, the foot and ankle are particularly vulnerable.
Stress fractures can affect people of all ages and activity levels, but certain groups are more susceptible:
- Active young adults and adolescents: Particularly those involved in high-impact sports such as running, gymnastics, basketball, tennis, and dance. The risk increases during periods of rapid growth when bones are still developing. Some research indicates an increasing prevalence of stress fractures in this age group due to increased training regimes and early sport-specific specialisation leading to overuse.
- Females: Women are more likely than men to develop stress fractures, particularly those with low bone density, irregular menstrual cycles, or low energy availability (as seen in the female athlete triad). Adolescent girls and women in endurance sports are at the highest risk.
- Older adults: As people age, bone density naturally decreases, increasing the risk of fractures, including stress fractures, especially in those with osteopenia or osteoporosis.
- Military personnel: New recruits and individuals undergoing intense physical training often experience a spike in stress-related injuries, including “march fractures” of the foot.
- People who rapidly increase physical activity: Whether returning to sport after a break or starting a new exercise regimen, a sudden increase in training volume or intensity can overload the bones and lead to micro-damage. This is particularly common in women over 40 who increase training as it coincides with menopause and a decrease in bone density.
Symptoms and Causes
Common Symptoms of Foot and Ankle Stress Fractures
Stress fractures often start with mild discomfort but can progress if left untreated. The most common symptoms noted by patients include:
- Localised pain: A dull, aching or sharp pain over a specific area of the foot or ankle, often worsened by weight-bearing activities such as walking, running, or jumping.
- Pain that improves with rest: Symptoms often ease when you stop the aggravating activity, but return quickly once you resume.
- Tenderness to touch: Pressing over the affected area usually causes pain, which may feel pinpoint and sharp.
- Swelling: Mild swelling may develop over the fracture site, especially after activity.
- Bruising: Less common, but may occur in some stress fractures.
- Pain with daily activities: As the fracture progresses, pain may be present even during regular walking or standing.
- Changes in gait: You might start limping or avoiding putting weight on the affected foot.
The orthopaedic team at Access Ortho is highly skilled in diagnosing orthopaedic injuries. Symptoms, mild or severe, will be considered when assessing patients to ensure an accurate diagnosis.
What Causes Foot and Ankle Stress Fractures?
Stress fractures are caused by repetitive overuse exceeding the bone’s ability to repair and adapt. Unlike acute fractures that happen suddenly, stress fractures develop gradually over time as small cracks form in the bone due to repeated impact.
Common Contributing Factors Include:
- Sudden increase in physical activity
Jumping into a new training program or dramatically increasing distance, intensity, or frequency of exercise without adequate progression.
- High-impact, repetitive activities
Running (especially on hard surfaces), dancing, basketball, tennis, marching, and gymnastics frequently cause stress fractures.
- Improper footwear
Shoes that do not have proper support or cushioning can increase stress on the feet and ankles.
- Poor biomechanics
Flat feet, high arches, leg length discrepancies, or abnormal gait patterns can alter force distribution and increase fracture risk.
- Low bone density or bone health issues
Conditions such as osteopenia, osteoporosis, or nutritional deficiencies (e.g. calcium or vitamin D) weaken bones, making them more prone to stress injury.
- Inadequate rest and recovery
Not allowing time for rest between sessions prevents the body from repairing micro-damage, increasing injury risk over time.
- Hormonal factors and low energy availability
Especially in females, irregular menstrual cycles or under-fuelling (as seen in the female athlete triad) can reduce bone density and increase fracture risk.
- Improper training surfaces
Running on hard or uneven surfaces (like concrete or cambered roads) can increase the impact on bones.
It is important to stop training if you have any symptoms of stress fractures, especially if you have had a recent change or increase in activity.
What are the Common Risk Factors for Stress Fractures in the Foot and Ankle?
The following can increase your risk of developing stress fractures in the foot or ankle:
- Biomechanical issues: Flat feet, high arches, leg length differences, or abnormal gait can overload specific bones.
- Inadequate footwear: Poorly cushioned, worn-out, or unsupportive shoes fail to absorb impact effectively.
- Training errors: Sudden increases in activity, lack of rest, poor technique, or training on hard surfaces can overwhelm bone recovery.
- Medical and nutritional factors: Low bone density, vitamin D or calcium deficiency, disordered eating, or hormonal imbalances (e.g. menstrual irregularities) weaken bones.
- High-impact activities: Sports like running, dance, basketball, and gymnastics place repeated stress on the foot and ankle.
- Lifestyle factors: Smoking, heavy alcohol use, or returning too quickly after injury can impair bone healing and increase injury risk.
What are the Complications of Untreated Foot and Ankle Stress Fractures?
When foot and ankle stress fractures are not properly diagnosed or managed, they can worsen over time and lead to more serious long-term problems. What starts as a small crack in the bone can escalate into a complex injury that affects mobility, daily function, and quality of life. It is therefore important to get rapid specialist orthopaedic advice if you have any symptoms associated with stress fractures. Access Ortho offers rapid appointments for orthopaedic acute injuries.
1. Complete Fracture
Without rest or offloading, the tiny crack can enlarge and result in a complete break of the bone, which may require a more extended period of recovery and, in some cases, surgical intervention.
2. Delayed Union or Non-Union
Some stress fractures may take longer to heal (delayed union), or fail to heal altogether (non-union), particularly in areas with limited blood supply, such as the navicular bone or base of the fifth metatarsal. These cases often require prolonged immobilisation or surgery.
3. Chronic Pain
Ongoing or worsening pain can persist long after the original injury, especially if the stress fracture was not properly treated early. This may interfere with walking, exercise, work, and sleep.
4. Altered Foot Mechanics
Compensating for pain can change how you walk or run, leading to abnormal loading on other joints or muscles. This can increase the risk of further injuries in the feet, ankles, knees, hips, or back.
5. Reduced Mobility and Activity Limitations
Persistent symptoms may reduce your ability to participate in sport, exercise, or even basic activities like walking or standing for long periods. In severe cases, this can affect overall fitness and mental well-being.
Access Ortho fracture clinics are located in Brisbane and Ipswich and offer rapid care for stress fractures.
Diagnosis and Tests
How are Foot and Ankle Stress Fractures Diagnosed?
Diagnosis of a stress fracture starts with a detailed clinical assessment by a healthcare professional. This includes:
- Medical and activity history: Your provider will ask about recent changes in physical activity, sports involvement, previous injuries, and any underlying medical conditions (e.g. bone health or nutritional status).
- Pain assessment: Stress fracture pain typically has a gradual onset, worsens with weight-bearing activity, and improves with rest. Your provider will ask about your pain to determine if it fits this pattern.
- Physical examination: This includes checking for:
- Localised tenderness over specific bones
- Swelling or subtle bruising
- Gait changes or limping
- Pain reproduction with certain movements or pressure
When a stress fracture is suspected based on clinical findings, imaging is typically ordered to confirm the diagnosis.
Which Tests do Providers Use to Diagnose Foot and Ankle Stress Fractures?
Imaging helps identify the location, severity, and healing stage of a stress fracture. Your provider may use one or more of the following tests:
- X-rays
The first-line imaging test. While useful, stress fractures may not be visible on X-rays until a few weeks after symptom onset. In some cases, signs like bone reaction or healing may appear later.
- MRI (Magnetic Resonance Imaging)
Highly sensitive and useful for early detection. MRI can detect bone stress injuries before a fracture line appears and is especially helpful for evaluating soft tissue and subtle injuries.
- CT Scan (Computed Tomography)
It offers detailed images of bone structure. It is often used for complex or high-risk stress fractures (e.g., in the navicular or talus) to assess fracture stability and guide treatment planning.
- Bone Scan
It is less commonly used today due to MRI availability, but it can detect bone turnover and inflammation. It may be useful when MRI is not available or contraindicated.
Rapid diagnosis is essential to prevent complications and guide proper management. If you’re experiencing ongoing foot or ankle pain following an increase or change to activity, it’s important to seek expert assessment early. Access Ortho has urgent injury orthopaedic clinics in Indooroopilly and Ipswich, offering rapid assessment and care of stress fractures.
Specific Considerations for Different Foot and Ankle Stress Fractures
Stress fractures in different bones have distinct symptoms, healing characteristics, and treatment requirements.
Metatarsal Stress Fractures
Metatarsal stress fractures are among the most common, especially in the second and third metatarsals. These bones absorb significant force during walking and running, particularly in people with high arches or abnormal gait patterns.
Clinical features:
- Localised pain and tenderness on the top of the foot
- Worsening pain with activity, often pinpoint to the shaft of the affected metatarsal
- Minimal to no swelling in early stages
Management considerations:
- Second and third metatarsals are midfoot stabilisers and require protected weight-bearing (e.g. moon boot or stiff-soled shoe)
- Return to full activity should be gradual to prevent re-injury
- Fifth metatarsal fractures (particularly at the base or shaft) are higher risk and may require longer immobilisation or surgery
Navicular Stress Fractures
The navicular is a small bone in the midfoot that plays a critical role in load distribution. Stress fractures here are considered high-risk due to the bone’s limited blood supply and central biomechanical role.
Clinical features:
- Vague or diffuse midfoot pain, often hard to localise
- Pain that worsens with hopping or sprinting
- Tenderness along the central dorsal midfoot
Management considerations:
- Often missed on X-rays — early MRI or CT may be needed for diagnosis
- May require non-weight-bearing in a boot or cast for 6–8 weeks
- Surgical fixation may be needed in delayed or high-grade cases
- Careful monitoring is necessary to prevent non-union or chronic disability
Calcaneal (Heel Bone) Stress Fractures
The calcaneus, in the heel, is the largest tarsal bone and a key load-bearing structure during standing and ambulation. These stress fractures are often associated with sudden increases in walking, marching, or running.
Clinical features:
- Deep, aching pain in the heel or rearfoot
- Pain on squeeze test of the heel (medial-lateral compression)
- May mimic plantar fasciitis early on
Management considerations:
- May not be visible on early X-rays — MRI or bone scan may be required
- Requires reduced weight-bearing and sometimes a period of non-weight-bearing, depending on severity
- Proper footwear and cushioning are essential during rehabilitation
- Gradual return to activity to avoid recurrence
Ankle (Malleolar) Stress Fractures
Stress fractures can occur in the medial or lateral malleolus, the bony prominences on either side of the ankle joint. These are less common but potentially serious due to the risk of displacement and joint involvement.
Clinical features:
- Localised pain and tenderness over the inner or outer ankle
- Pain aggravated by twisting movements or running
- Swelling may be minimal or absent
Management considerations:
- Diagnosis often requires MRI or CT, especially for medial malleolar injuries, which carry a higher risk of non-union
- Treatment may range from immobilisation in a boot to surgical fixation for unstable or high-risk fractures
- Early recognition is important to prevent progression to a full fracture
Management and Treatment
How are Foot and Ankle Stress Fractures Treated?
Treatment of foot and ankle stress fractures depends on multiple factors, including the location, severity, risk of non-union, and patient activity level. While many stress fractures can be managed conservatively, certain high-risk injuries require more intensive treatment or surgical intervention.
The main goals of treatment are to:
- Relieve pain
- Prevent fracture progression
- Promote complete bone healing
- Allow safe return to activity and reduce re-injury risk
The orthopaedic team at Access Ortho will tailor a treatment plan based on imaging findings, physical examination, and the patient’s individual needs.
Non-Surgical Treatment Options for Foot and Ankle Stress Fractures
Most stress fractures, particularly low-risk ones in areas with good blood supply (e.g. metatarsal shafts, calcaneus), heal successfully with conservative care. Stress fractures picked up early will also have a better chance of a good outcome. Key components include:
- Activity modification: Temporary avoidance of high-impact activities such as running, jumping, or prolonged walking.
- Protected weight-bearing:
- Use of a Moon-Boot, stiff-soled shoe, or crutches to offload the affected area.
- Non-weight-bearing may be recommended for more severe cases (e.g. navicular stress fractures).
- Pain management: Ice, elevation, and paracetamol or anti-inflammatories (as advised) may help relieve symptoms.
- Footwear and orthotic support:
- Supportive shoes with arch support and cushioning
- Custom orthotics may be needed to correct biomechanical issues and redistribute load
- Physiotherapy: Once healing is underway, some patients will benefit from a structured rehabilitation program including:
- Range of motion and strengthening exercises
- Gait retraining
- Gradual return-to-sport planning to avoid recurrence
Healing time ranges from approximately 6 to 8 weeks, but may vary depending on fracture location and individual healing rates.
Surgical Treatment Options for Foot and Ankle Stress Fractures
Surgery is typically reserved for high-risk, unstable, or non-healing stress fractures. These often occur in bones with limited blood supply or those subject to high mechanical stress. Common indications include:
- Navicular stress fractures
- Base of the fifth metatarsal (Jones fractures)
- Medial malleolar stress fractures
- Non-union or delayed union after conservative treatment
- High-level athletes requiring faster or more predictable recovery
Surgical approaches may involve:
- Internal fixation with screws or plates to stabilise the bone
- Bone grafting in cases of poor healing
- Post-operative rehabilitation with staged return to weight-bearing
Surgical intervention aims to reduce healing time, prevent long-term complications, and allow a safe return to sport or work. Recovery time may be longer initially, but often results in improved long-term outcomes when conservative treatment fails.
If the orthopaedic team at Access Ortho feels you need surgery, they will discuss the pros and cons and help arrange it for you.
Preventing Foot and Ankle Stress Fractures
Stress fractures often develop due to a combination of training errors, poor biomechanics, and inadequate support. Fortunately, several simple strategies can significantly reduce your risk:
1. Gradual Progression
- Increase training intensity, distance, or duration slowly and steadily—typically no more than 10% per week.
- Incorporate rest days to allow bones time to adapt and recover.
2. Supportive Footwear
- Wear well-cushioned, activity-specific shoes with good arch support.
- Replace worn-out shoes regularly—every 600–800 km for running shoes.
3. Consider Orthotics
- Custom orthotics may help correct flat feet, high arches, or gait imbalances contributing to stress injury.
- A podiatrist or physiotherapist can assess your foot mechanics and recommend inserts if needed.
4. Strength and Conditioning
- Include exercises to improve foot, ankle and core strength, balance, and flexibility.
5. Listen to Your Body
- Don’t ignore early signs of pain. Persistent or localised discomfort with activity should be assessed by a professional.
Outlook / Prognosis
What Can I Expect if I Have a Foot or Ankle Stress Fracture?
With early diagnosis and appropriate treatment, most foot and ankle stress fractures heal well and allow a full return to normal activity. However, recovery timelines and outcomes depend on the specific bone involved, the severity of the fracture, and adherence to the treatment plan.
- Low-risk fractures (e.g. metatarsal shafts) typically heal well with conservative care.
- High-risk fractures (e.g. navicular, fifth metatarsal base, medial malleolus) may require longer offloading or surgical intervention to prevent complications such as non-union or chronic pain.
Complications are uncommon when stress fractures are diagnosed early and managed correctly. The team at Access Ortho are trained in the care of stress fractures.
What is the Recovery Time from a Foot or Ankle Stress Fracture?
Recovery time varies based on the bone involved, the extent of the fracture, and the treatment method. The following are general guides to healing timelines:
- Metatarsal stress fractures: 6–8 weeks
- Calcaneal (heel) stress fractures: 8–10 weeks
- Navicular stress fractures: 8–12 weeks or longer, often non-weight-bearing
- Fifth metatarsal base fractures (Jones fractures): 8–12 weeks, sometimes longer with surgical fixation
- Medial malleolar stress fractures: 8–12+ weeks, often requiring surgery in athletes
Healing may take longer in those with low bone density, poor nutrition, or delayed diagnosis.
When Can I Return to Walking, Running, and Sports?
Return to activity should be gradual and guided by symptom resolution and professional advice. General phase-based guidelines:
- Walking: Walking is usually permitted in a boot once pain subsides; transition to normal shoes after 4–8 weeks, depending on fracture location and healing.
- Running: It may resume 8–12 weeks after injury, provided walking is not painful and imaging confirms healing. A walk-jog progression is recommended.
- Sports: Full return typically occurs 10–14 weeks or more after treatment starts, depending on the sport’s demands and the location of the fracture. Athletes should undergo a structured rehab program that includes strength, balance, and sport-specific drills.
Tip: Rushing back too early increases the risk of re-injury or delayed healing.
When Should I Go to a Fracture Clinic for Foot or Ankle Pain?
While mild foot or ankle pain may improve with rest and simple care, there are specific warning signs that suggest you should seek assessment at a dedicated fracture clinic:
- Persistent pain lasting more than 5–7 days, even with reduced activity
- Pain that worsens with walking or weight-bearing
- Localised tenderness over a specific bone
- Swelling, bruising, or pain when putting weight on the foot or ankle
- Pain that returns quickly after resuming activity
- Pain when combined with a recent increase in training, running, or repetitive impact
- A history of bone stress injuries, known low bone density
Early assessment is important to prevent a stress fracture from worsening into a complete break, and to avoid delayed healing or long-term complications.
What is a Foot and Ankle Fracture Clinic?
A foot and ankle fracture clinic is a specialised service focused on the rapid assessment and management of foot and ankle injuries. These clinics provide timely care for stress fractures, broken bones, sprains, and other musculoskeletal concerns, avoiding long delays often experienced in Emergency Departments or through general care pathways.
At Access Ortho, we offer:
- Rapid referral for X-rays and prompt image review
- Expert clinical assessment by orthopaedic-trained Nurse Practitioners
- Fitting and sale of moon boots, crutches, and offloading advice
- Follow-up appointments with orthopaedic surgeons skilled in the care of foot and ankle injuries
- Clear treatment plans and return-to-activity guidance
Whether you’re an athlete, worker, or simply on your feet a lot, Access Ortho provides efficient, expert care to get you moving again.
Commonly Asked Questions About Foot and Ankle Stress Fractures
How can I tell if my foot pain is a stress fracture or a sprain?
Stress fractures usually cause gradual, pinpoint pain that worsens with activity and improves with rest. Sprains are often linked to a specific injury and involve swelling, bruising, or joint instability.
Do I need to wear a boot for a metatarsal stress fracture?
Yes, most metatarsal stress fractures require a moon boot or stiff-soled shoe to protect the area and allow proper healing.
Can I walk with a stress fracture in my foot?
Walking is usually limited initially. Protected or reduced weight-bearing is often advised to prevent the fracture from worsening.
How long does a navicular stress fracture take to heal?
Navicular stress fractures are high risk and typically require 8–12 weeks of offloading and close monitoring. In some cases, surgery may be needed.
What’s the best type of footwear during recovery?
Supportive shoes with a firm sole, good arch support, and shock absorption. Avoid flat or flexible shoes like thongs or worn-out runners.
Are custom orthotics necessary after a stress fracture?
They’re not always needed, but orthotics may help if you have flat feet, high arches, or abnormal gait that contributed to the injury.
Will I need crutches?
Crutches may be recommended if pain is severe or if non-weight-bearing is needed for high-risk fractures.
Can I continue swimming or other non-weight-bearing exercise?
Yes. Activities like swimming, cycling (with care), or upper-body workouts are typically safe during recovery, but always check with your provider.
How soon can I return to running after a metatarsal stress fracture?
Usually after 6–8 weeks, once pain-free walking is possible and imaging confirms healing. A gradual return-to-run plan is essential.
Are stress fractures more common in certain sports?
Yes, running, dance, basketball, tennis, gymnastics, and military training all carry higher risks due to repetitive impact.
What’s the difference between a Jones fracture and a fifth metatarsal stress fracture?
A Jones fracture is a specific, high-risk fracture at the base of the fifth metatarsal. Unlike more distal stress fractures, it may heal slowly or require surgery.
Does a stress reaction always progress to a stress fracture?
Not always. With proper rest and load modification, early intervention can prevent a stress reaction from becoming a full fracture.
How do I modify my footwear after recovery?
Choose well-cushioned, supportive shoes and consider orthotics if advised. Avoid minimalist footwear or unsupportive shoes, especially on hard surfaces.
Can flat feet or high arches increase my risk?
Yes. Abnormal foot mechanics can cause uneven load distribution, raising the risk of stress injuries, especially with poor footwear or increased activity.
What exercises should I do during recovery?
Rehab often includes range of motion, foot and ankle strengthening, balance training, and eventually impact control exercises to support a safe return to activity.
Who should I see if I think I have a stress fracture?
You should see a healthcare provider experienced in musculoskeletal or orthopaedic injuries, ideally at a dedicated fracture clinic like Access Ortho. Our orthopaedic-trained clinicians can assess your symptoms, refer you for appropriate imaging, and develop a personalised treatment plan without the long wait for hospital or specialist appointments.