Foot Stress Fracture: Treatment Options, Recovery, and Prevention

Both nonsurgical and surgical treatment options are used to treat foot stress fractures. The majority of stress fractures are treated non-surgically and most athletes are able to return to normal activity within 2 to 8 weeks.

Nonsurgical Treatment Options

In order for a foot stress fracture to heal, most physicians will advise athletes to stop or modify activities that cause pain. In addition to avoiding certain activities, the RICE method is recommended:

• Rest. Limit weight-bearing on the affected foot until it has time to heal. Low-impact activities, such as swimming or cycling, are good alternatives while resting.
• Ice. Apply ice packs to the injured area to reduce swelling and decrease pain.
• Compression. Decrease or stop swelling by wearing an elastic bandage around the injury.
• Elevation. Raise the foot above heart level when lying down in order to decrease swelling.

See The P.R.I.C.E. Protocol Principles

While not all weight-bearing activities can be restricted as a foot stress fracture heals, it is important to avoid or modify the activity that caused the injury in the first place.

In addition to the RICE method, a physician may suggest the following:

• Take over the counter medication, such as ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol), to reduce pain and swelling.
• Use protective footwear, such as a stiff-soled shoe, wooden-soled sandal, or a removable short-leg fracture brace (walking boot). Protective footwear reduces stress on the foot.
• Apply a cast to keep bones in a fixed position while they heal and to reduce stress on the affected leg. Casting will depend on the location of the injury; navicular and certain metatarsal stress fractures take longer to heal when compared to other bones.
• Use crutches to keep weight off the injured foot while it heals.
• Take daily supplements, such as vitamin D or calcium, if the stress fracture occurred because of a nutrition deficiency.

If foot stress fractures do not heal after a full course of nonsurgical treatment options, a physician may recommend surgery.

Surgical Treatment for Foot Stress Fractures

Some foot stress fractures do not heal well with conservative treatment and are termed ‘high-risk’ stress fractures. Some of the more common high-risk stress fracture sites include the following bones: ¹ Greaser MC. Foot and Ankle Stress Fractures in Athletes. Orthop Clin North Am. 2016 Oct;47(4):809-22. doi: 10.1016/j.ocl.2016.05.016. Epub 2016 Aug 9.

• Medial Malleolar Stress Fracture
• Navicular Stress Fractures
• Talus Stress Fracture
• Sesamoid Stress Fractures
• Proximal Fifth Metatarsal Stress Fractures

High risk fractures typically require more invasive treatment to heal, such as surgery. Surgery to treat a foot stress fracture is called internal fixation.

Internal fixation surgery
Internal fixation is an outpatient procedure, which means it does not require an overnight stay in the hospital. Typically performed under local or general anesthesia, an orthopedic surgeon will make a small incision over the fractured bone and use surgical screws, pins, or wires to anchor the bone in its proper place.

Once the incision is closed, the surgeon will apply a protective dressing and splint or cast the foot. A follow-up surgery may be required to remove the stitches or staples used in the surgery, although in many cases these surgical materials are designed to be absorbed into the body.

Foot Stress Fracture Recovery

It can take between 2 and 8 weeks to fully recover from a foot stress fracture. More serious fractures can take longer and may require additional treatment options.

A physician may wish to perform a diagnostic imaging exam in order to confirm the foot stress fracture has healed. An athlete is generally ready to return to high-impact activities once they are able to perform low-impact activities without pain for an extended period of time.

Modify workout schedule to avoid re-injury
Since stress fractures are often the result of overuse or repetitive activities, a physician may suggest integrating rest days into an athlete’s exercise schedule. Additionally, incorporating cross-training, such as swimming or biking, may help avoid worsening the stress fracture or reinjuring the bone, which can lead to more severe symptoms and longer recovery times.

Foot Stress Fracture Prevention

Patients with a history of prior stress fracture are at a greater risk of developing future stress fractures, and appropriately adjusting activities, nutrition, and other risk factors is essential to prevent development of a new stress fracture.

Read more about Stress Fracture Treatment and Prevention