The Center for Podiatric Care and Sports Medicine

Stressed Bones: Causes & Treatments For Minor Fractures of the Foot

Posted by on Thursday, August 29th, 2013


Soccer fans were disappointed to learn that English footballer Ben Foster of West Bromwich Albion will be out for at least three months with a stress fracture in his foot that will require surgery. “There’s no hiding the fact this is disappointing news, as Ben is a key player for us,” manager Steve Clarke said of the goalkeeper. It turns out Mr. Foster is not alone. Stress fractures are a very common injury for professional athletes.   Here Here at our NYC Center for Podiatric Care and Sports Medicine, we see these kinds of injuries at every level of athleticism, from professionals down to weekend footballers and in every sport.

Causes of Stress Fractures: Knee Rotation

Stress fractures are small cracks that occur over time from repeat trauma. Sports like running, soccer, football and basketball can really take a toll on the bones, which tend to be overused. Frequency, intensity and duration of exercise are said to be the biggest risk factors. However, a recent study of 2,000 military cadets found that the angle of the knee during foot landing increases the likelihood of a stress fracture.

Researchers say it would be helpful for sports medicine professionals to evaluate a person’s running form to assess whether a person is at high risk for a stress fracture or not. From there, the  bio-mechanical expert can guide the athlete to wear custom-fitted shoes, change the stride, strengthen surrounding muscles and tendons, or alter one’s diet to remain healthy and active.

Treatment For Stress Fracture: Casting

“Treatments range from allowing the patient to remain weight-bearing without a cast or a boot all the way to open reduction, internal fixation, and bone grafting,” Dr. Thomas O. Clanton explained at an American Orthopaedic Foot and Ankle Society (AOFAS) symposium. he said. Rest is not an effective option anymore, he adds. Several studies indicate 86 to 100% healing rates using nonsurgical treatment like use of a non-weight-bearing cast over for six to eight weeks, with a gradual return to sports after four to six months.


Despite the effectiveness of casting, AOFAS researchers found that 82% of the time, patients did not wear a cast — but rather, opted to rest in addition to performing occasional weight-bearing activities. This led to a number of delayed unions, non-unions and other complications. Athletes, in particular, are rarely willing to sit around and wait for six months. Therefore, surgery has become more popular as the first line of treatment in sports medicine.

Treatment For Stress Fractures: Surgery

Surgery is required when the bones have become displaced, are completely fractured all the way through the bone, are broken in several different places (a comminuted fracture), or when there is delayed union of bone during conservative treatment. Patients with sclerosis or cystic degeneration are also good candidates for surgery.

During stress fracture surgery, short percutaneous screws are temporarily used to hold partial fractures in place while they heal. Bone grafts and postsurgical bone growth stimulation are used to treat non-unions. With a more aggressive form of stress fracture treatment, it is possible to return to elliptical machines, stationary bikes and swimming in four weeks and resume most regular activities by eight to ten weeks.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.