Whether you are a runner or you play another sport, finding out that you have a foot stress fracture can set you back. Should you be worried about it? Some foot stress fractures can be more serious than others. These “high-risk” stress fractures have a tenuous blood supply, forces that pull the fracture apart or other factors that increase the chance that your stress fracture doesn’t heal.

Here are four stress fractures of the foot and ankle that orthopaedic surgeons consider high risk. For each one I discuss who is most at risk for suffering them and possible treatment options for them.

Foot stress fracture #1: Navicular stress fracture

The navicular is a bone in the midfoot. This small bone in the foot withstands a lot of stress when you perform repetitive jumping or sprinting. Navicular stress fractures are fairly common among basketball players. You might notice pain along that bone on the top of your foot at the level of your arch.

Also read:
Navicular Stress Fractures

The challenge with a navicular stress fracture is that these foot injuries are prone to nonunion. If an orthopedic surgeon and patient decided to treat your stress fracture without surgery, we usually require you to remain strictly nonweightbearing for at least 6 to 8 weeks in a cast. We often perform early surgery to place one or two screws across the bone.

Location of the navicular, a common foot stress fracture

Foot stress fracture #2: Fracture of the base of the fifth metatarsal

Basketball and soccer players often suffer stress fractures of this bone. The fifth metatarsal is the long bone along the outer border of your foot. Like most stress fractures of the foot, you often notice that your pain increases as you ramp up your training or physical activity. You will notice pain at the base of this metatarsal.

Also read:
Fifth Metatarsal Fracture (Jones fracture)

Some stress fractures of the base of the fifth metatarsal can heal without surgery. The physician might place you in a cast and make you strictly nonweightbearing for 6 to 8 weeks. Since these stress fractures often occur in elite or high-level athletes, orthopaedic surgeons often perform surgery soon after finding the fracture on x-rays. We place a screw down the center of the bone to compress the fracture site. You can often return to sports in 6 to 10 weeks, but your fracture must heal completely to safely return to sports and exercise.

Foot stress fracture #3: Medial malleolus stress fractures

Athletes or active individuals in jumping, kicking, and running sports can develop stress fractures of the medial malleolus. The medial malleolus is the bony prominence on the medial (side closest to the midline of the body) side of the ankle. You can cause an overuse injury to this bone by increasing your training without adequate rest.

Like most high-risk stress fractures of the foot, treatment can entail many weeks in a cast or boot while you remain nonweightbearing. Early surgery to place screws across the fracture might allow you to return to sports or exercise more quickly, assuming your stress fracture heals properly.

Medial malleolus, another common foot stress fracture

Foot stress fracture #4: Stress fractures of the sesamoid

Athletes and active individuals who perform repetitive dorsiflexion of the great toe, like ballet dancers, occasionally suffer these foot overuse injuries. The sesamoids are the small bones located under the first metatarsal head (the ball of the foot). You might notice pain under the ball of your foot as a sesamoid stress fracture develops. Orthopaedic surgeons often start treatment with a period of immobilization, rest from the sport or activity, orthotics, or even a cortisone injection into the painful area. Surgery to either compress the fracture with screws or to remove part or all of the involved sesamoid bone are options for some patients.

Also read:
Stress fractures: Frequently asked questions
Ask Dr. Geier – Navicular Stress Fractures
Ask Dr. Geier – Stress Fractures

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