Do you have a stress fracture of the calcaneus?

Stress fractures are a reasonably common overuse injury in athletes, especially where these is lot of repetitive motions such as running. In runners almost any bone can get a stress fracture. A stress fracture is micro cracks that appear in the bone as the result of too much repetitive loading. Bone is a very dynamic stricture and can adapt to load on it if it is given time. If increased loads from activities such as running are increased very gradually, then the bone will adapt to those increased loads and become stronger. However, if these loads are increased too rapidly and the bone is not given a chance to adapt, then a stress fracture might happen. This is more likely to also happen if there are issues with the health of the bone such as osteoporosis, lack of vitamin d and low calcium. Females are more at risk of developing a stress fracture. Stress fractures generally heal without any complications if given adequate time to recover. However, stress fractures can be divided into what are considered high risk and low risk. A high-risk stress fracture is one that could have complications such as an avascular necrosis. These types of stress fracture need special care.

A common low risk stress fracture is a calcaneal stress fracture that affects the heel bone. When running the heel bone is what we hit the ground with and the Achilles tendon also pulls on the bone, so a lot of stress gets put through the heel bone. If the amount of running is increased gradually and slowly, then a calcaneal stress fracture is less likely. When a stress fracture does occur in the calcaneus, there is gradually increasing pain in the heel bone. Most occur towards the back of the bone, but some do occur in the middle and a few towards the front. A characteristic feature is the pain is positive to the calcaneal squeeze test. For this test, you squeeze the heel bone from the side and that elicits pain, often being very tender.

With a calcaneal stress fracture, rest in the first week or so is really important. The athlete is going to need to stop running and substitute another activity to maintain fitness for a least a week or so in order for healing to get started. Nutritional issues and bone health issues are going to need to be assessed and addressed if needed. In the most severe cases, a moon boot or walking brace may be needed to help. Once the pain settles, it is then time to very slowly and gradually increase the activity levels. If this is not done carefully, it is common for the stress fracture to happen again or flare up. The symptoms can be carefully monitored using that calcaneal squeeze test. If you have a stress fracture of the calcaneus, plan on this return to full activity taking a few or more months on top of that initial rest period of a few weeks or so. If you do it quicker, then it might happen again.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.