Running Foot Pain or Stress Fracture?

Pain is often a runner’s most loyal training partner, free from the busy social calendars or alarm clock failures that leave you pounding the pavement solo during those early-morning 5 milers.

Differentiating “normal” pain from one that merits a visit to your local sports medicine specialist is the tricky part of that relationship.  Let me help you address this problem to keep you healthy and happy…and running pain-free.

The Inside Scoop on Foot Stress Fractures

Stress fractures located in the foot are usually characterized as an overuse injury to weight-bearing bones.  High-impact sports that involve running and jumping contribute to simple foot pain and, if left untreated, can lead to a more serious problem like stress fractures.

Bones generally respond to stress by hardening along their outer margins.  When suddenly exposed to strong forces or ongoing stress, there is little time for bones to adapt. Meanwhile, muscles associated with the feet lose their shock-absorbing capacities when fatigued. These uncontrolled forces inadvertently transfer to nearby bones, possibly resulting in small cracks that are better known as stress fractures.

Stress fractures commonly occur in distance runners along the outer ridge of the forefoot over the fifth metatarsal bone. This is often referred to as either a Jones fracture or a Dancer’s fracture, depending on location.

Statistically, women are more prone to stress fractures than men due to biomechanics, nutrition and possibly menstrual cycles. Running an excessive amount of miles in a short time span with insufficient rest increases the risk of generalized foot pain, plantar fasciitis, turf toe, metatarsalgia and stress fractures.

Obviously, any underlying bone disease or disorder will drastically increase one’s risk for these conditions. Outlined below are key characteristics and recommendations with respect to these aches and pains:


Signs & Symptoms of Stress Fractures in the Foot

  • Localized foot bone pain that is dull, aching or sharp and occurs during activity (especially running) and/or periods of rest
  • Mild widespread foot swelling and tenderness
  • Pain that worsens with prolonged exposure to ice and during sleep
  • An initial sensation of sharp pain followed by intensifying aching
  • Related lower-extremity symptoms such as lateral thigh/knee pain, low back tightness and/or Achilles tendonitis due to altered foot mechanics sometimes observed in runners


Professional Treatment for Foot Pain in Runners

  • Get plenty of rest and apply ice.
  • Avoid placing excessive weight on the affected foot.
  • Wear shock-absorbing footwear, and if symptoms worsen, use a walking boot to help mitigate stress on the injury site.   
  • Eat healthy and ingest the Recommended Daily Allowance (RDA) of calcium and vitamin D to help restore bone integrity.
  • Engage in strength training for the arch, toe flexors and weak muscles, which may have contributed to the initial injury.
  • Maintain an ideal range of motion for surrounding muscles and joints, specifically the Achilles, calf, plantar fascia, great toe and ankle joint.


Ask the Right Questions Like a Pro

Here’s what smart pro athletes would ask a sports medicine specialist to ensure a fast and safe return to their beloved game or sport:

1. What do you believe is the main reason(s) why this injury occurred?

2. How can I best manage this pain and safely return to running?

3. Do I need orthotics and if so, which foot doctor(s) do you recommend I discuss treatment with, specifically as a runner?

4. Should I concern myself with any potential long-term issues associated with this pain?


Elite Sports Medicine Tips from Mike Ryan


  • Time is of the Essence – Visit a sports medicine specialist as soon as symptoms appear to best manage foot pain from the onset.
  • Rest Rocks – It’s boring, but REST is the #1 tool to tame a stress fracture.  For how long, you ask?  Prepare yourself for 2 to 6 weeks of inactivity if symptoms persist.
  • Be a Turtle, Not a Hare – Resume your running regimen slooooowly. Include pool running, run/walk routines and off-road routes while increasing your miles by no more than 10% per week.
  • Mix It Up – Cross training is king. Add varied activities such as biking, swimming, yoga, strength training and elliptical training to stay in shape and save your “marriage” during this break from running.
  • Smooth and Steady – Wear stable and proper-fitting shoes to protect your feet.
  • No Big Break – Stress fractures can easily develop into typical bone fractures if left untreated.  Setting limitations from the get go can help you avoid the “big break.”