EDITOR'S NOTE: While the injuries du jour - or at least the ones that get most of the attention- in July of 2026 tend to be more soft-tissue-centric like achilles tendonitis, runner's knee, or plantar fasciitis, bone injuries to the foot are still very much a problem in our sport. This 2019 article by Nico Composto remains an excellent resource if you think you're developing a stress reaction or stress fracture!
Nothing strikes fear into the hearts of distance runners
quite like the possibility of a stress fracture. Unlike most muscular injuries, which one can usually treat through physical
therapy with the hope of a speedy recovery, a stress fracture means nothing
other than weeks or even months off from running.
Stress fractures are caused
by repeated forces against the bone, leading to the formation of a small crack.
While they can occur in many bones of the leg, this article will focus on
stress fractures in the foot.
Initially, a stress fracture will cause just a small, dull
pain or a feeling of weakness in the foot. Most runners will not be concerned
with this pain and will run through it, causing the injury to worsen. As a
stress fracture progresses, the pain becomes sharp, deep and localized. If one
continues to run despite the pain, eventually it can become unbearable to run
or even put any weight on the foot.
Diagnosis of a stress fracture can be challenging, as there
is often no exterior manifestation of the injury. There might be a small amount
of swelling, but there is never any bruising. There are several injuries in the
foot that could feel similar to a stress fracture, notably plantar fasciitis, which causes pain underneath the foot. The only real way to
determine the cause of foot pain is to visit a doctor. The diagnosis of a
stress fracture typically requires an x-ray or an MRI. While x-rays are usually
the first step, they often won't reveal a stress fracture until after it has
already started to heal. Most patients require an MRI to get a definitive
diagnosis. And in some cases, a doctor may even be able to confirm a diagnosis using a tuning fork!
Once an athlete knows they have a stress fracture, the first
step of rehab is to stop running entirely. Many runners who suffer from stress
fractures of the foot require crutches or even immobilization devices, such as
a walking boot, to allow the fracture to heal appropriately. It is important
that an athlete recognize that the injury can take quite a bit of time to heal,
potentially several months.
Trying to run too soon could lead to a
reaggravation of the injury. Athletes with stress fractures of the foot can do
zero-impact cross-training activities, such as swimming, until they are able to
run again. When the pain has completely disappeared and the greenlight has been
given by the doctor, an athlete may begin slowly returning to running.
Of course, it's important to understand why a stress injury occurred in the first place. For most younger athletes, the culprit tends to be one of the following:
- Overdoing it in training or rapidly changing the volume or intensity of your training can both be factors.
- A nutritional deficiency - not enough calcium, vitamin D, or overall caloric intake - can cause weakness in bones.
- Or training in worn out or improperly fitting shoes.
Stress fractures are scary because they force us to take
time off running. But at the end of the day, most fractures only take 6-8 weeks
to heal and then we are able to get back to running. If we are careful not to jump
back into running too quickly, a stress fracture need only be a minor setback
in an otherwise healthy running career.