Treatment of Stress Fractures of the Foot and Ankle

Stress fractures of the foot and ankle are common in competitive athletes and can cause a considerable delay in return to play. Generally, management of stress fractures includes rest and immobilization. When they occur in female athletes, treatment will begin with an analysis of metabolic bone health, which will involve blood and urine testing, and a bone scan for bone density. If hormonal issues or eating disorders are discovered, a multidisciplinary treatment plan may be necessary. 

How is a stress fracture treated?

Your OANC orthopedic surgeon or sports medicine specialist will determine whether the stress fracture is low risk or high risk. Low risk stress fractures can be treated conservatively. High risk stress fractures may be treated conservatively or surgically depending on the patient’s activity level and choice.

First and foremost, when a patient suspects a problem with the foot or ankle because the sport or activity causes pain, they should immediately stop all activities that cause pain and use conservative measures including rest, icing, compression and elevation, and over the counter pain medications. Additionally, activity modification is important to eliminate stress on the fracture; and to avoid more serious injury or reinjuring the affected bones. Activity modification may include cross training, swimming, cycling, and elliptical workouts to maintain strength and fitness.

When the patient cannot walk without pain, the use of a walking boot or stiff soled shoe may be recommended to protect the foot and ankle. After a period of pain-free rest a gradual return to activity with physical therapy will be recommended. Usually it takes about 4 – 8 weeks to heal a stress fracture.

Confirmation that your stress fractures are healed is accomplished with x-rays. A CT scan can help in determining whether the fracture line is healed. Once healed, a gradual return to normal activity, training to restore strength and flexibility, modifying levels of intensity and stopping if pain or swelling returns are recommended. When these guidelines are followed most stress fractures will heal on their own.

However, some stress fractures have a poor ability to heal on their own and may require treatment with a cast and no weightbearing. High risk stress injuries may require surgical intervention to heal correctly. Surgery will involve internal fixation with screws and plates to hold the small bones together while they heal. Generally, surgery is usually recommended only after conservative measures fail to provide relief.

Your OANC sports medicine expert can provide information on how to prevent stress fractures in the future. If the pain continues or returns schedule an appointment with OANC.