Diagnosing a Foot Stress Fracture

Receiving an accurate diagnosis will require a visit to a health care professional and typically begins with a patient interview and physical examination. Diagnostic imaging may be ordered to help confirm a diagnosis.

Patient Interview

In order to make an accurate diagnosis, a physician will need to know a person’s medical history as well as any known risks factors for developing a stress fracture. The physician will likely ask for:

• A full medical history, including past injuries (especially previous stress fractures), hospitalizations, and any medications currently prescribed.
• Lifestyle habits, including diet, exercise, and daily activities.

In cases of recurring stress fractures a physician may order a full medical work-up, which includes blood tests, to determine if nutritional deficiencies, such as low Vitamin D, may be a factor in the injury.

Physical Exam

Following the patient interview, a physician may perform a physical exam to confirm the diagnosis of a foot stress fracture.

Typically, this a simple examination in which the physician applies pressure to the suspected injured bone; If pain or tenderness reported in response to pressure, a stress fracture is the likely diagnosis.

Following a physical exam, a physician may order diagnostic imaging to rule out other injuries and confirm the diagnosis of a foot stress fracture.

Diagnostic Imaging

One or more of the following diagnostic imaging exams may be used to confirm the presence of a foot stress fracture.

• X-rays use low levels of radiation to provide images of dense structures in the body, including bone. X-rays are usually the first diagnostic imaging exam that is performed. Stress fractures are often difficult to see on X-rays immediately following the injury and may only be noticeable once the injury has begun to heal, which may be 10 to 14 days following the onset of pain. X-ray imaging may be repeated after some weeks if a fracture is suspected but was not initially visible.
• Magnetic Resonance Imaging (MRI) uses a strong magnetic field and radio waves to show a detailed view of the soft tissue surrounding the bone. It can be used to identify abnormalities surrounding a stress fracture. These abnormalities will show up on an MRI 1-2 days following injury.

• Ultrasound is a sensitive test that can detect stress fractures in superficial bones, such as the bones of the feet.
• Bone scans use a radioactive substance (called a tracer) that is injected into the bloodstream and a special scanner, which can detect the substance and produce pictures of bones. A stress fracture will appear darker on a bone scan when compared to an uninjured area.
• Computed Tomography (CT) scans use radiation to create a picture of the bones and joints of the foot and can be used to look for stress fractures as well as to plan the best approach if surgery is needed for treatment.

Read more about Stress Fracture Diagnosis

MRI is generally considered the gold standard in identifying stress fractures because of its high sensitivity and ability to detect fracture lines. ¹ Fredericson M, Jennings F, Beaulieu C, Matheson GO. Stress fractures in athletes. Top Magn Reson Imaging. 2006 Oct;17(5):309-25. doi: 10.1097/RMR.0b013e3180421c8c. Review. PubMed PMID: 17414993. ^{, 2} Mandell JC, Khurana B, Smith SE. Stress fractures of the foot and ankle, part 1: biomechanics of bone and principles of imaging and treatment. Skeletal Radiol. 2017 Aug;46(8):1021-1029. doi: 10.1007/s00256-017-2640-7. Epub 2017 Apr 4.