February 13, 2018
Stress fractures of the foot are becoming more common in runners, especially first-time marathoners, according to San Antonio, Texas foot and ankle surgeon Eddie Davis, DPM, FACFAS.
The growing popularity of marathons among beginning runners has contributed to the increase in repetitive stress injuries, including stress fractures of the foot, seen by Dr. Davis, a member of the American College of Foot and Ankle Surgeons. Often, first-time marathoners enter a race with little or improper long-distance training. The lack of experience coupled with the repetitive impact placed on the feet during the run can produce enough stress to cause hairline breaks in the bones of the foot.
“Runners who increase their mileage too quickly or change to a more intense phase of training may be more susceptible to a stress fracture due to the increased force placed on the bones,” says Dr. Davis. “A general rule of thumb for runners is to increase the mileage by no more than 10 percent each week. Runners who are training also need to have adequate rest time in between runs to help decrease the risk of a fracture.”
Runners at all levels of experience are also at higher risk for stress fractures if they wear improper shoes while running or training, suffer from flatfoot or other foot deformities, or have osteoporosis. Signs of a stress fracture can include pain, swelling, redness and possibly bruising of the area.
“Stress fractures can occur anywhere in the foot and can eventually lead to a complete break of the bone if left untreated,” Dr. Davis explained.“Early diagnosis and treatment are important to ensure proper healing.” Stress fractures often do not show up on x-ray until several weeks after healing start. Davis has been an early adopter of high sensitivity ultrasound to diagnose metatarsal stress fractures early.
Osteoporosis may predispose female runners to stress fractures.For additional information on stress fractures due to osteoporosis, visit
If a break is suspected, Dr. Davis advises runners to immediately follow the RICE protocol—Rest, Ice, Compression and Elevation. If pain and swelling last longer than a few days, an appointment for an imaging and diagnosis is in order.
In most cases, treatment includes rest and immobilization with casting of the foot. Surgery may be required in certain instances to repair and stabilize a stress fracture that has progressed into a full fracture.
Runners can take action to prevent repetitive stress injuries in their feet by wearing supportive athletic shoes and slowly building up their activity levels according to their abilities. “If a runner suffers from abnormal mechanics in the foot, such as over pronation or hypermobility, custom orthotics can also be helpful to prevent these injuries,” Dr. Davis, adds.
If you suspect you have a foot injury or fracture, call Dr. Davis’ office at (210)490-3668 for an evaluation.
For additional information on stress fractures and other foot injuries, visit
Eddie Davis DPM PLLC
109 Gallery Circle, Suite 119
San Antonio, TX 78258
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