A stress fracture of the ankle, also known as a hairline fracture, is a small micro-fracture of the bone. These minuscule fractures affect many people, from elite athletes to relatively inactive older adults.
Stress fracture ankle symptoms include pain, swelling, and immobility. Our definitive injury guide tells you everything you need to know about stress fractures in the ankle—from causes and symptoms to effective treatment options and expected recovery time.
What is a Stress Fracture of the Ankle?
Stress fractures are tiny cracks or severe bruising within a bone. Most stress fractures are caused by overuse or repetitive force, but they can also occur in people whose bones have been weakened by osteoporosis or other conditions.
The feet and ankles are frequently affected by stress fractures, as they are subjected to so much force through our everyday activities of walking, jumping, and running.
Although stress fractures of the metatarsals (long thin bones in the feet) are the most common type of fracture experienced, a stress fracture of the ankle is also a regular occurrence, particularly in athletes and older adults.
Outside of the foot, other types of stress fractures include:
- Stress fractures of the fibula (calf bone)
- Stress fractures of the shin
- Stress fractures of the pelvis
Ankle Stress Fracture Causes
The majority of stress fractures of the ankle and other bones in the foot arise from repetitive injury and overuse. They occur when bone—which adapts gradually to increased loads—is suddenly exposed to a greater than normal force. Bones which aren’t given adequate recovery time are unable to destroy old bone and rebuild new bone (a normal process known as remodeling) fast enough to meet demand. Therefore, the bones are vulnerable to stress fractures.
Stress Fracture Ankle Risk Factors
Several factors increase your risk of experiencing a stress fracture of the ankle. These include:
Engaging in sports which require repetitive motions that stress the feet and legs, such as running, basketball, tennis, and gymnastics, are more likely to cause stress fractures than low-impact activities, such as swimming and cycling.
Changing Activity or Increasing Activity Level
If you suddenly switch to a high-impact activity or significantly increase your workouts in terms of frequency, duration, or intensity, you may experience a stress fracture of the ankle.
Bones that are weak are naturally more prone to stress fractures. Certain medical conditions and medications can decrease bone strength and density.
For example, osteoporosis—a bone disease which affects 10 million Americans—is a common cause of stress fractures of the ankle.
Because women are more likely to experience osteoporosis (80% of osteoporosis cases are in women), they are more at risk of ankle stress fractures.
Some research suggests that female athletes are more likely to experience stress fractures than their male counterparts, due to lower bone density.
If you have flat feet or high arches, you’re at higher risk of stress fractures because certain areas of the foot—including the ankle—are under more strain than if the arches were a healthy shape.
Vitamin D deficiency, more common in the winter months, increases the risk of stress fractures in the ankle. A lack of calcium also negatively impacts bone health.
History of Stress Fractures
Those who have already had a stress fracture in their ankle or foot are at greater risk of suffering another.
Stress Fracture Ankle Symptoms
Ankle stress fracture symptoms tend to develop gradually. Initially, you may notice a slight pain, which gets worse over time. The most common symptoms include:
- Pain, which may lessen in severity during rest and increase during activity
Diagnosing an Ankle Stress Fracture
Your doctor will base the diagnosis on a full medical history, physical examination, and imaging tests.
Medical History and Physical Examination
Firstly, your doctor will take a medical and family history and inquire about your lifestyle, activity levels, and diet.
Blood tests may be ordered to check for low levels of nutrients such as calcium and Vitamin D.
The doctor may then examine the foot and ankle to check for areas of pain and tenderness. A good ankle stress fracture test is to press on the ankle. Pain caused by pressure to this region is often indicative of a stress fracture.
Imaging tests may be ordered if the doctor to confirm the doctor’s initial diagnosis. Imaging tests include:
The images collected during an X-ray may show a stress fracture. However, during the early stages of an injury, the fracture may be too small to see in X-ray images. Sometimes it is only visible when a callus forms after several weeks. A callus indicates the bone is beginning to heal.
This scan is more sensitive than an X-ray and is more likely to show a stress fracture, particularly if the injury is recent. A bone scan, although less specific than an MRI, may also be used.
Stress Fracture Ankle Treatment
Many treatment options are available for stress fractures in the ankle, ranging from simple at-home therapies to surgery for more serious cases. Available treatments include:
Probably one of the best-known protocols for dealing with all kinds of injuries, the RICE protocol helps kill pain and inflammation within the first 72 hours following a stress fracture. It comprises:
Rest. Many people ask, “Can you walk on a stress fracture?” Although you can, it’s best to rest the foot in the immediate aftermath to give your bone time to heal. Whenever you get the opportunity, take a load off your feet. If you must walk, your doctor may recommend a walking boot to keep your ankle safe.
Ice. Apply an ice pack to your ankle for 15 minutes every 4 hours, or as necessary. This helps reduce pain and inflammation.
Compression. If you suffer from swelling at the site of the stress fracture, an elastic compression bandage may help ease symptoms. You may also use a compression ankle support.
Compression reduces swelling and improves circulation to help you heal faster. ( See Product )
Elevation. By raising your ankle above heart level, you’ll restrict blood flow and fight inflammation. Simply prop your foot on a chair or pillows.
Inappropriate footwear—such as high heels or worn-out running shoes—can increase your risk of developing stress fractures in the ankle. Wearing shoes like this when you already have a stress fracture may impact your chances of making a full recovery.
When buying footwear, check for good arch support. This helps with proper foot alignment and shock absorption, while reducing the risk of developing flat feet or high arches.
Once your running shoes show obvious signs of wear to the arches and soles, it’s time to replace them. A good rule of thumb is to buy new training shoes every six months, or more frequently if you’re very active. Help your shoes last longer by using a shoe horn to prevent damage.
Using a shoe horn helps your shoes last longer, while also saving your back by reducing the need to bend over. ( See Product )
Stress Fracture Ankle Brace
Braces keep the ankle and foot in a neutral position, which aids recovery and reduces pain and swelling. Once recovered, you can even wear your ankle brace during activities to reduce the risk of another stress fracture or other ankle injury.
Look for a wraparound ankle brace that’s easy to adjust to your exact specifications—too loose and it won’t do its job, too tight and it will cause additional damage. Also, select one that is washable and made from a breathable fabric.
Wraparound ankle braces provide adjustable support and compression, customized to your needs. ( See Product )
These supportive devices decrease weight on the ankle and help correct a limp. A cane is a simple solution, if you are still able to put some weight on the ankle.
A folding cane is easy to take with you while traveling, preventing slips and falls no matter where you are. ( See Product )
Whereas crutches or a knee walker keep you from placing any weight on the injured ankle.
Knee walkers allow you to retain mobility and independence while your ankle is injured. ( See Product )
Both crutches and canes provide much-needed R&R for the damaged bone in the ankle. As the fracture heals, you can gradually begin to walk with more weight on the foot.
Stress fractures of the ankle take longer to heal than fractures to other bones in the foot. Therefore, you may require a cast to keep your bones aligned in a fixed position. Casts also reduce the amount of stress on the ankle.
Your doctor may recommend you wear a cast for up to eight weeks. Don’t forget to protect your cast from getting wet with a cast protector for the shower.
A qualified physical therapist can provide education and guidance on suitable exercises and activity modifications. They also identify lifestyle changes to help reduce stress on the ankle bone, which facilitates recovery and reduces the risk of future injury.
Stress fractures of the ankle that cause significant pain may be managed with over-the-counter pain relievers, such as aspirin and ibuprofen.
Discuss usage of these drugs with your doctor beforehand, particularly as they come with side-effects.
Stress Fracture Ankle Surgery
Surgical intervention is usually unnecessary for ankle stress fractures. However, in rare cases, some fractures may require surgery to ensure they heal completely.
Athletes that wish to return to activities quickly, or people whose work involves strain on the ankle, may be candidates for ankle surgery. Don’t forget to use a post-op shoe to protect your ankle after surgery.
If your injury requires surgery, a post-op boot is important to ensuring your fragile ankle heals properly. ( See Product )
Stress Fracture Ankle Recovery
When it comes to a hairline fracture of the ankle, healing time falls between six and eight weeks. However, more serious stress fractures can take longer to heal.
The key to a successful recovery is avoiding high-impact activities until your doctor or physical therapist gives you the go ahead. Once you do return to physical activities, take it slow and gradually increase your activity level. This gives your bone adequate time to grow in response to increased activity levels.
When you do start working out again, begin with low-impact activities that don’t put too much weight on the ankle. Examples of low-impact exercises include:
Returning to activities too soon puts you at serious risk of re-injury, which could lead to stress fractures that don’t heal properly and chronic ankle problems.
How to Prevent Stress Fractures
A stress fracture puts you out of action and increases the risk of future fractures and chronic ankle problems. Follow these six tips to prevent a stress fracture from occurring in the first place.
1. Increase Activity Levels Slowly
Whether you’re engaging in a totally new activity or intensifying an old favorite, it’s imperative you do so gradually to avoid injury. Experts recommend a 10% increase in duration, frequency, or intensity per week.
2. Eat for Your Bones
Aim to eat a well-balanced diet, full of whole grains, leafy greens, colorful fruits and vegetables, and lean protein sources. This ensures you get enough calcium, magnesium, and Vitamin D for bone health.
3. Check your Footwear
Make sure your shoes have proper arch supports and shock absorbers and don’t show signs of wear on the soles. If necessary, use insoles to correct flat feet and to provide even higher levels of support.
Insoles are an easy and cost-effective way to maximize your shoes' comfort and safety. ( See Product )
4. Mix Up Your Workouts
By choosing a good mix of high- and low-impact activities (or sticking to low-impact ones, depending on your needs), you’ll reduce your risk of ankle stress fractures and a host of other foot injuries.
5. Strength Train
Incorporating strength training into your weekly regimen is one of the most effective ways to prevent loss of bone density. Strength training with bodyweight, free weights, or resistance bands builds bones, muscles, and overall strength to reduce the risk of injury.
If you’re unsure about adding strength training to your workouts, consult a fitness professional. Remember, proper form is key.
Scheduling in rest days is just as important as engaging in regular activities. If you experience any pain or swelling following activity, stop and rest. Symptoms that persist beyond a few days suggest you need to see your doctor.
Products that Help Reduce Stress Fracture Ankle
Relieve Stress Fracture Ankle Pain
Now that you know how stressful having a stress fracture of the ankle can be, take the appropriate measures to avoid injuring the bones of your ankle and feet.
Incorporate low-impact activities, and increase exercise duration and intensity slowly. By eating well, checking your footwear, and getting plenty of rest, you can ensure you stay mobile and fracture-free.
If you’re worried you already have a stress fracture in your ankle or foot, use the RICE protocol and consult your doctor immediately.