Avoid Running into Trouble: Foot Pain, Swelling Could Signal Stress Fracture
Now that spring has arrived, we’ll be spending more time outdoors. Many people will return to walking or running for exercise or playing outdoor sports after being cooped up at home over the winter. It’s the time of year doctors tend to see an increase in overuse injuries, which occur from repetitive stress on a muscle, bone or joint over time. People often develop this type of injury after ramping up a sport or athletic activity too quickly.
One of the most common overuse injuries is a stress fracture, and the foot is particularly vulnerable, according to Mark C. Drakos, MD, an orthopedic surgeon specializing in foot and ankle injuries at Hospital for Special Surgery (HSS) in New York City and medical director of HSS Long Island in Uniondale.
Repeated impact on a bone that is starting to weaken from overdoing it can eventually lead to a small break or crack. A stress fracture does not cause the bone to shift position. “When people think of bones, they think they’re hard like metal, but the bones in the foot are more like tree branches. They can bend a little bit, and if you bend them enough times, they can crack,” said Dr. Drakos, who is an assistant team orthopedist for the New York Knicks. “The foot is one of the most common locations to sustain a stress fracture because we are constantly on our feet.”
The foot is an anatomical marvel, with 26 small bones, 33 joints and a network of more than 100 muscles, tendons and ligaments that work together to support our body weight, provide stability, and allow movement. Our feet are designed to absorb a tremendous amount of force with every step we take.
Stress fractures are often seen in runners, in athletic people who participate in high-impact repetitive sports and in older people who have weakened bones, Dr. Drakos says. Individuals who don’t rest adequately in between workouts or keep playing a sport despite exhaustion are at increased risk, as are people who take steroids.
David A. Wang, MD, a sports medicine physician at HSS Paramus in New Jersey, saw an increase in stress fractures in people who were inactive during the pandemic lockdown and then resumed an activity too quickly. “The challenge is that when you’ve been inactive for so long, the body gets weaker and cannot handle an activity at the previous intensity,” he explains. “We still want people to be active, and the cliché I always use is ‘slow and steady wins the race.’ The key is to gradually build up your activity to make sure your body can handle the load. If you’ve never run before and want to start running, for example, start with walking first, then jogging and then gradually start running.”
The main symptom of a stress fracture is pain, which generally occurs in the spot where the bone is broken, according to Dr. Drakos. People may also experience swelling and bruising. Anyone who may have suffered a stress fracture is advised to immediately stop any activity that is causing the discomfort. The main treatment for a stress fracture is rest.
For pain that comes on suddenly, people can try using ice and elevating their foot to see if the pain improves. If it doesn’t get better after a few hours or people start experiencing pain on days they’re not working out, the experts recommend seeing a doctor.
A stress fracture is diagnosed based on a discussion with one’s doctor about recent activities, any possible injury and where the pain is felt. The physician will examine the foot and order X-rays. Sometimes a CT scan or MRI is also prescribed to make the diagnosis.
Surgery is rarely needed for a stress fracture, according to Dr. Drakos. “As a general rule, many fractures of the foot can be treated without surgery by wearing protective shoe wear: either an orthopedic boot or a hard-soled shoe. People can generally put weight their foot when wearing the protective footwear.” Most stress fractures heal in four to six weeks.
Dr. Drakos says lifestyle choices and good habits can lower the risk of developing a stress fracture, not only in the foot, but in other bones as well. He says people should support their bone health with adequate consumption of calcium and vitamin D. He has seen many patients who were found to be deficient in vitamin D, which can also affect healing.
He also stresses the importance of wearing supportive shoes. “Flimsy footwear such as flip flops or ballet slippers do not provide adequate support,” he says. “We take more than a million steps a year. So, if you take 5,000 to 10,000 steps a day in shoes that aren’t giving you a lot of support, it’s that much extra stress on your feet with every step you take.”
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.