Stress Fractures – Calcaneus: Causes, Symptoms, and Treatment

What Is a Calcaneal Stress Fracture?

The calcaneus is the largest bone in the foot and serves as the primary weight-bearing structure of the heel. A stress fracture in this bone typically develops gradually from repetitive impacts, rather than a single traumatic event.

Causes of Calcaneal Stress Fractures

Repetitive Impact and Overuse

• Long-distance running, especially on hard surfaces.

• Activities with repetitive jumping or heavy landing forces.

• Marching or hiking with poorly distributed loads (e.g., heavy backpacks).

Biomechanical and Foot Structure Issues

• High arches (pes cavus) or flat feet (pes planus), which can alter force distribution.

• Improper running technique or biomechanical imbalances.

External and Lifestyle Factors

• Sudden increases in activity intensity or volume.

• Inadequate footwear lacking proper cushioning and support.

Bone Health and Medical Factors

• Osteopenia or osteoporosis reducing bone strength.

• Nutritional deficiencies in calcium or vitamin D affecting bone repair.

Symptoms of a Calcaneal Stress Fracture

• Localized Heel Pain: Pain on the inside or back of the heel, often worse with weight-bearing activities.

• Swelling and Tenderness: Mild swelling and tenderness on palpation of the calcaneus.

• Pain Progression: Symptoms starting as mild and worsening over time with continued activity.

• Discomfort at Rest: Advanced cases may result in persistent pain, even at rest.

Diagnosing a Calcaneal Stress Fracture

Clinical Assessment

• Detailed history of activity levels and symptom progression.

• Physical examination to identify localized pain and swelling.

Imaging Studies

• X-rays: May show signs of healing stress fractures or callus formation but often appear normal early on.

• MRI or Bone Scan: The most sensitive methods for detecting early-stage stress fractures.

Treatment for Calcaneal Stress Fractures

Non-Surgical Management

1. Rest and Load Management

   • Avoid weight-bearing activities to reduce stress on the calcaneus.

   • Use crutches or a walking boot to immobilize the heel during healing.

2. Physiotherapy

   • Strengthening Exercises: Focused on the muscles supporting the foot and ankle to reduce future stress on the calcaneus.

   • Flexibility and Range of Motion: Gentle stretches to maintain mobility in the ankle and foot.

   • Biomechanical Correction: Addressing contributing factors such as gait abnormalities or muscle imbalances.

3. Pain and Inflammation Management

   • Ice therapy to reduce swelling and relieve pain.

   • Nonsteroidal anti-inflammatory drugs (NSAIDs) as advised by a doctor.

4. Footwear and Orthotics

   • Transition to supportive footwear with adequate cushioning.

   • Custom orthotics to correct alignment and distribute forces more evenly.

Surgical Management

Surgery is rarely required but may be considered for:

• Persistent fractures that fail to heal with conservative treatment.

• Fractures complicated by displacement or bone degeneration.

Recovery Timeline

• Initial Healing Phase: 6–8 weeks of non-weight-bearing rest for bone repair.

• Rehabilitation Phase: Gradual reintroduction of weight-bearing activities with physiotherapy guidance.

• Full Recovery: Typically 2–4 months, depending on the severity of the fracture and adherence to treatment.

Preventing Calcaneal Stress Fractures

• Gradually increase activity intensity and avoid sudden changes in training routines.

• Wear well-cushioned, supportive footwear suitable for your activity type.

• Incorporate strength training for the foot and lower leg muscles to support the heel.

• Ensure adequate intake of calcium and vitamin D to maintain bone health.

At Palms Physiotherapy & Allied Health, we are committed to providing personalized care to help you recover from calcaneal stress fractures and prevent future injuries. Contact us today to learn more about our evidence-based treatment programs.