Stress Fractures of the Foot & Ankle

About Stress Fractures of the Foot & Ankle

Stress Fractures

What Causes Stress Fractures?

Stress fractures occur as a result of repetitive and prolonged stress on a bone. Simply put, the bone breaks when its ability to absorb a force is overtaxed.

Stress fractures occur as a result of repetitive and prolonged stress on a bone. Simply put, the bone breaks when its ability to absorb a force is overtaxed.

  • Anatomic variations of the foot or ankle, such as a high arch, long second metatarsal, or loose ankle ligaments
  • Hormonal imbalances (hyperthyroidism, amenorrhea)
  • Poor nutrition
  • Anemia
  • Smoking
  • Heavy alcohol consumption
  • Poor training techniques
  • Improper footwear

Stress fractures occur as a result of repetitive and prolonged stress on a bone. Simply put, the bone breaks when its ability to absorb a force is overtaxed.

Types of Stress Fractures

Stress fractures can be divided into 2 categories: a stress reaction, the initial weakening of the bone, and the stress fracture, when the weakened bone eventually breaks.

Stress reactions typically cause discomfort over the bone that is worsened with activity and improves with rest. It can be diagnosed with a physical exam and an MRI to identify the location of the injury. If the injury has progressed to a stress fracture, an MRI and x-ray will show a fracture line.

The most common types of stress fractures in the feet and ankles include:

  • Tibial stress fractures - Stress fractures in the tibia (shinbone) are common in active patients. These stress fractures tend to cause tenderness around the middle of the shinbone, along with pain at the inner part of the bone. Less commonly, stress fractures can occur at the front of the shin, typically from repetitive jumping.
  • Malleolar stress fractures of the ankle - The inner and outer sides of the ankle are called the medial (inner) malleolus and lateral (outer) malleolus. Stress fractures of the malleoli tend to occur with repetitive jumping activities and often cause pain and swelling around the malleoli itself.
  • Metatarsal stress fractures - The metatarsal bones are a group of five long bones in the foot. Structural differences in the foot and ankle, such as flatfoot, ruptured or weakened plantar fascia, or long or short second metatarsal place excess stress on the forefoot and can cause a stress fracture. Metatarsal stress fractures are often called “march fractures,”' as they are commonly diagnosed in military recruits due to repetitive marching. The second and third are the most fractured metatarsals.
  • Fifth metatarsal stress fractures - The fifth metatarsal is a curved bone along the outer edge of the foot. Stress fractures of the fifth metatarsal are particularly common, and there are different classifications depending on the location of the fracture. This type of stress fracture is particularly common among dancers, and treatment and healing times vary depending on the type and location of the fracture. Dr. Kovatis advises patients to inquire about the Jones fracture as this is a unique fifth metatarsal fracture with differing treatments depending on age and athletic expectations.
  • Calcaneal stress fractures - The calcaneus, or heel bone, is the most common location for a stress fracture in the foot. This type of stress fracture is commonly seen in military recruits and patients involved in activities that require repetitive high impact to the heel area.

Treating Stress Fractures of the Foot & Ankle

Dr. Kovatis recommends that any patient who is experiencing worsening pain over a bony area should be evaluated for a stress fracture. If the stress reaction is caught early enough, it may be treated before it progresses to a fracture.

In the vast majority of cases, stress fractures are initially treated with nonsurgical methods. However, surgical options are available and may be recommended if a fracture is displaced or does not heal.

If a patient is diagnosed at the stress reaction stage, 6-8 weeks of activity modification (avoiding impact and any force that contributed to the injury) will typically heal the injury.

Stress fractures are also initially treated with activity modification. This includes avoiding the activity that caused the stress fracture and other activities that require impact in the injured area. If a fracture does not heal, or if the bone is displaced, surgery may be considered to realign the bones and fix them in place so that they heal properly.

The majority of stress fractures will heal within 4-16 weeks, depending on factors like age, conditioning, and adherence to the treatment plan. In most cases, patients are able to return to activity when pain subsides.

Foot & Ankle Stress Fracture Treatment in Bergen County

Dr. Paul Kovatis is a fellowship trained surgeon specializing in foot and ankle care, including the treatment of stress fractures. He has over 24 years of clinical experience treating foot and ankle injuries in athletes and dancers. Stress fractures can occur in several places in the foot, ankle, and lower leg, particularly among active patients. With early diagnosis, many patients can heal without surgery under the guidance of Dr. Kovatis. If the bones are displaced or if the fracture does not heal on its own, Dr. Kovatis is also experienced in surgical methods to fix the bones in place so that they heal in the correct position.

If you would like to schedule an appointment with Dr. Kovatis, please call our office at (201) 489-0022.

Contact Us


87 Summit Avenue
Hackensack, NJ 07601
Phone: (201) 489-0022


140 North State Route 17, Suite 255
Paramus, NJ 07652
Phone: (201) 261-5501


111 Dean Drive, Suite 1 North
Tenafly, NJ 07670
Phone: (201) 489-0022
Phone lines open 24/7 for on-call emergency care.