Foot pain is a scary thing for runners. It can mean a major setback in training or even a missed starting line. A common foot injury to runners that can be prevented is a stress fracture. Stress fractures are micro-fractures in the bone resulting from repeated impact. A runner’s foot strikes the ground approximately 800 times per mile and takes an impact up to 3-4 times their body weight each time. Your body must absorb the impact of each step by dispersing the shock throughout your bones and tissues. When that impact is too great, tiny hair-line fractures begin to form in the bone and increase with each additional run. The most common site of stress fractures in the feet of runners is the 2nd metatarsal; this is the long bone from your 2nd toe that runs back on the top of your foot.


A deep, nagging pain that is localized to a specific spot on your foot may be the sign of a developing stress fracture.  The pain will increase with impact and often first appears midway through your training runs. It may progress to the point where even walking is painful.  Usually symptoms of a stress fracture show up 2-3 weeks after you make a major change in your training program. Major changes include increased weekly mileage, a change in running surface such as soft trail running to hard pavement or even returning to running after a long layoff. These are all common causes of stress fractures because your body does not have time to adapt to the sudden increased impact. Poor footwear can also lead to stress fractures. Old and worn shoes will not properly absorb or spread the impact.


A simple check for a stress fracture is to perform a metatarsal compression test. Using a firm hand, squeeze around the ball of your foot compressing the ends of the long bones together. The inducement of pain can be a sign of a stress fracture. Other signs of a stress fracture can include localized swelling around the painful area and in some cases a limp or compensation in your walk due to pain. Imaging such as x-rays will not show a stress fracture until at least 2 weeks after the initial injury.


The standard treatment for stress fractures is a four letter word for most runners…REST. The only way the bone will heal is to eliminate the impact that is causing the problem. A good option to maintain your fitness during recovery is low impact aerobic cross training such as biking or elliptical machines. Once given time to heal, a GRADUAL return to your running will prevent a reoccurrence of stress fractures (see previous article: “When can I get back to running after an injury”). Remember, you can prevent a stress fracture in the first place by following these simple guidelines – always increase your training load gradually, 10% per week, and wear proper footwear. The impact absorbing qualities of footwear typically only lasts between 300-500 miles. Also, as always make sure you are practicing good bone health with a nutritious, vitamin rich diet.


Be sure to check with your primary care provider for a proper medical diagnosis and plan of care.  The statements in this article are for educational purposes only and should not be construed as medical advice or a prescription of care.