Stress Fracture Healing Time

The stress fracture healing time is dependent on many factors such as the seriousness of the fracture, whether multiple stress fractures have been sustained and also the location of the fracture. Some bones in the foot will take much longer to heal and will require an extended period of absence from sports and weight bearing activities to allow healing of stress fractures to take place.

Although casts are not always recommended for the treatment of stress fractures – immobilizing the foot and taking rest is important and may be sufficient. Certain stress fractures may warrant a cast, in particular stress fractures of the fifth metatarsal. It is relatively rare for this type of stress fracture to be suffered, with the second and third metatarsal much more likely to sustain stress fractures. The healing time for metatarsal stress fractures in second and third metatarsal is generally shorter.

The First Few Weeks of Healing Are Critical

One of the most important aspects which can affect the healing time of stress fractures considerably is that the first few weeks of recovery involve complete rest with no weight bearing activity. A gradual return to weight bearing should then take place after 4 weeks, with only limited weight bearing exercise over the following month to six weeks. During recovery from foot stress fractures it may be recommended that you wear an air brace to immobilize the foot, and stiff soled shoes can be highly beneficial to prevent unnecessary movement.


Speeding up the Healing Time of Stress Fractures

If you suspect you have sustained a stress fracture it is important that all weight bearing activity is ceased until such time as you can have an examination by a doctor. Continuing with sports or even walking has potential to cause the stress fracture to increase in severity, which can delay the healing time considerably.

In the majority of cases, the healing time for stress fractures will be in the region of 6-8 weeks, although in some cases -metatarsal stress fractures on the outside of the foot and midfoot fractures for instance – the healing time can be considerably longer, and up to 12 weeks or more is not uncommon.

Depending on the location of your stress fracture your doctor may recommend splinting the foot or wearing an air brace to keep the foot immobilized. One of the main problems which can affect stress fracture healing time is when weight bearing is commenced too quickly. Many avid runners and athletes are keen to return to training quickly; however the bones will remain weak for some time and there is always the possibility of re-injuring the bone. During the first weeks after a stress fracture has been sustained it is possible to undo any healing which has already taken place, sending you back to square one. Should the fracture develop further it may require surgery to correct, and the affected bone may need to be pinned in place to facilitate the healing process.

Healing Time for Metatarsal Stress Fractures

Metatarsal stress fractures (with the exception of stress fractures of the fifth metatarsal) generally heal in around 6-8 weeks, with the healing time significantly improved with casting or by wearing a stiff soled shoe to reduce movement in the foot. During the first few weeks, walking and weight bearing should be limited with a gradual return after around 4-6 weeks or as advised by your doctor.

Healing Time for Heel Stress Fractures

Calcaneal stress fractures are a common overuse injury and the healing time for stress fractures in this location is highly variable. The location of the fracture and its severity will dictate the best treatment, although you can expect several weeks from any weight bearing activity if you have a heel stress fracture. The use of crutches or a boot will therefore be necessary to help with the healing process. Although light exercise can be commenced after just a few weeks in most cases, a full return to pain free exercise and pre-fracture levels is unlikely to be possible for at least 3 months.

Slow Healing Stress Fractures of the Foot

The healing time for certain foot stress fractures can be much longer, especially with fractures to the fifth metatarsal, talus or navicular bone. Any region of the foot which has a relatively low blood supply will take longer to heal, and in many cases surgical treatment will be required to ensure proper union of the fractured bones.

Healing Time for Fifth Metatarsal Stress Fractures

The fifth metatarsal stress fracture is dreaded by many athletes due to the time these fracture can take to heal. The blood supply in this area of the foot is low, the healing time much greater, and the chances of the bones healing properly without surgical intervention is much lower than with other metatarsal stress fractures.

The stress fracture healing time for fifth metatarsal stress fractures is likely to take at least 12 weeks. The healing time can be quickened by refraining from all weight bearing activity and by using a crutch, or a cast may be recommended for this type of stress fracture to speed up the healing time.
It is important that the exact nature of a fracture to this bone is properly assessed, as the three main types of fracture of the fifth metatarsal have different treatments and the fracture healing time will be different for all three types.

5th Metatarsal Avulsion Fracture Healing Time

An avulsion fracture is typically quick to heal. This type of fracture is usually caused when a tendon pulls at the point where it inserts into the fifth metatarsal. This type of fracture is usually not treated by surgery, and rest and immobilization is all that is required. Pain medication, icing or a rigid shoe to prevent movement can help during the healing process. Avulsion fracture healing time can be as low as 4-5 weeks or up to 12 weeks. The application of a Jones dressing can help reduce the recovery time as opposed to wearing a short leg cast¹.

Jones Fracture Healing Time

A Jones fracture can involve a much longer healing time. This fracture is typically caused by a sudden impact when the foot is flexed and the toes are pointing downwards, such as when a lateral force is applied to the foot while in this position. This type of fracture may take up to 20 weeks to heal², although surgical treatment may be recommended not only to speed up the stress fracture healing time, but due to the relatively low success rate of proper healing this type of fracture without surgical intervention.

Fifth Metatarsal Stress Fracture Healing Time

A true stress fracture of the fifth metatarsal may only require a healing time of between 6-8 weeks if caught early, although typically these fracture can take considerably longer to heal as they often have been allowed to progress before treatment is sought. The healing time for stress fractures in this location can be highly variable depending on where exactly the fracture has occurred. Fractures at the base of the metatarsal can take longer to heal.

A return to sports is unlikely to be possible for at least three months until the fracture has had time to heal properly. Due to the low blood supply in this area it may be necessary to screw the fractured bones in place to facilitate the healing process.

Navicular Stress Fractures Healing Time

Stress fractures of the navicular bone in the midfoot can also be particularly slow to heal, and it is not unusual for 12 weeks of initial recovery followed by limited exercise. A return to sports and higher impact activities would usually be recommended only after 4-5 months. Casting for this type of stress fracture can be highly beneficial with a non weight bearing cast applied initially for the first month to 6 weeks, with a similar period then spent in a weight bearing cast.

It is important to remember that even after a sufficient healing time has been allowed that exercise is resumed gradually after any foot stress fracture. The bones in the feet will be weakened by a fracture and to avoid further injury it is vital that exercise is resumed gradually and not at the level before the fracture was sustained. If you experience any pain on a return to sport it is vital that the activity which caused it is stopped. Pushing through the pain is only likely to result in further healing time being required.


References

¹Wiener BD et al – Treatment of fractures of the fifth metatarsal: a prospective study – Foot Ankle Int. 1997 May;18(5):267-9.
Joshua Baumfeld, MD, David Diduch, MD – Fifth Metatarsal Fractures – theacc.com
²Fifth Metatarsal Fractures and Surgery – Dr Mark S. Myerson, M.D
American Academy of Family Physicians – http://www.aafp.org