Rehabilitation (Stress fracture of the foot)

The following guidelines are for information purposes only. We recommend seeking professional advice before beginning rehabilitation.

Aims of rehabilitation:

• To allow the stress fracture to heal.
• To maintain and improve mobility and flexibility.
• To strengthen the muscles of the foot and lower leg.
• Return to full fitness.
• Prevention.

Allowing the stress fracture to heal

• Rest from aggravating activities. This will usually mean no running or weight bearing activities, however swimming and cycling may be possible.
• If pain is severe, or a stress fracture of the base of the second metatarsal is diagnosed then non weight bearing on crutches for at least 4 weeks may be required. A doctor may even apply a plaster cast in some cases.

Improving mobility and flexibility

• As long as pain allows, mobility and stretching exercises can begin.
• Specific mobility exercises for the foot should be done as well as general stretching of the foot and lower leg.
• Maintaining the muscles of the lower leg in good condition will accelerate rehabilitation once the athlete can begin running again.
• Mobility and stretching exercises should be done on a daily basis.

Strengthening

• Strengthening exercises can begin as soon as they can be done without pain. If it hurts then don't do it!
• Exercises specifically designed to strengthen the small muscles of the foot as well as the larger muscles of the lower leg are important.
• By maintaining good strength in the foot and lower leg, the rehabilitation process should be faster.
• It is important to include proprioceptive exercises in a strengthening programme. These are balancing and coordination type exercises which should reduce the chance of re-injury, particularly ankle sprains.

Return to full fitness

• Once the obligatory rest period has been served, the athlete may begin to return to normal weight bearing training. One indicator of this is if the bone is no longer sore to touch.
• This should be a gradual process. The athlete who has maintained good muscle condition through stretching, strengthening and sports massage will be at an advantage over the athlete that has allowed their muscles to waste away and tighten up.
• Begin running only half a mile and increase running distance in stages by only around 400m each session.
• Running on soft surfaces such as grass is a good idea to begin with.
• Ensure you have good quality shoes that are not worn out and are designed for the job you are using them for.
• If at any time pain is felt then rest or lower training intensity until there is no pain.

Prevention of stress fractures

• Keep a training diary. Ensure that training intensities and distances are increased gradually.
• Check shoes are still in good condition.
• Have foot biomechanics checked. If the athlete over pronates then this can cause increased forces in areas of the foot and should be corrected with orthotic devices.