Calcaneal Stress Fractures

The calcaneus, or heel bone, is subject to stress fracture in the active person.  A stress fracture occurs when there are repetitive, abnormal forces being absorbed by a normal bone.  This commonly occurs in the calcaneus in runners or in military personnel that spends a lot of time marching.  It is particularly common in those individuals who have a sudden increase in activity, such as an increased mileage while running.

The symptoms of calcaneal stress fractures include heel pain that is made worse with activity.  The onset of pain is typically insidious, or gradual.  The pain is often differentiated from plantar fasciitis by squeezing on the heel bone from the sides.  This will often hurt in a calcaneal stress fracture, but not in plantar fasciitis. 

X-rays are taken if there is suspicion of stress fracture, but will often not show anything until 2-3 weeks after the injury has occurred.  By this time, it is more likely to see evidence of healing bone in the form of callus formation on the x-ray.  If a stress fracture is diagnosed, or is a likely diagnosis, the foot must be kept non-weight bearing and the patient must rest for a minimum of 6-8 weeks while the bone can heal.  If a person continues to walk and/or run on a calcaneal stress fracture, it can turn into a complete fracture of the calcaneus, which carries a much more ominous prognosis.

If a stress fracture is suspected, activity should be stopped and the person should see a foot and ankle specialist right away.  X-rays and a careful clinical examination are generally enough to determine the problem.  Occasionally a CT or MRI may be performed for a more thorough image of the calcaneus and the rest of the foot. 

Treatment for a stress fracture involves rest and cessation of weight-bearing activity.  The patient is often placed in a cast for several weeks while the bone is allowed to heal.  Crutches may be useful in offloading the foot.  Occasionally calcaneal stress fractures are seen on both feet.  In particular this can be seen in individuals beginning a new training program, such as an amateur runner who suddenly increases their activity. 

Upon returning to activity, it is important for the patient to begin a gradual return to activity.  Increasing their activity level too quickly can result in continued pain, additional stress fractures, and even a complete fracture of the previously affected bone. 

Central Florida Foot & Ankle Center, LLC 
101 6th Street N.W. Winter Haven, FL 33881 
Phone: 863-299-4551 
www.FLFootandAnkle.com