“Pain in left foot after waking?”
I am 22 year old female with no significant PMHX. I went for a walk last night (did not fall, trip, or hurt myself). I went to bed last night feeling fine, I then woke up this morning and took a step with my left foot and immediately toppled over in agonizing pain (9/10). I am unable to put any weight on my left foot and the pain is on the lateral side of my ankle right over the calcaneus. Is it possible I have a stress fracture?
Female | 22 years old
Complaint duration: 01/01/01
Medications: none
Conditions: none
10 Answers
Yes, a stress fracture is a possibility. Yet at 22 yoa with a negative PMHX, signals it is probably another cause. I would recommend that you either visit your Chiropractor or Primary Care Provider. Let them exam this ankle and order an X-ray to rule out a fracture.
I would recommend an X-ray with a foot and ankle specialist to rule out a stress fracture. Peroneal tendonitis is common in the anatomic area you are describing as well. If initial x-rays are negative, an MRI may be necessary. A stress fracture is defined as a hairline crack in a specific bone, which is a result of excessive stress in a particular area of the lower extremity. There are three types of stress fractures commonly encountered in the lower extremity.
Overuse Injury: Overuse injuries are the most common type of stress fracture encountered in our practice. This type of stress fracture occurs due to overuse and an increase in demand on a particular bone in the lower extremity. An overuse stress fracture either occurs in athletes (i.e. running, aerobics) who consistently place stress in a particular area of the lower extremity until the bone fatigues due to over demand or when an individual begins a particular exercise (i.e. walking) and begins to place stress in a particular area that has not been properly conditioned. These types of stress fractures usually occur in the metatarsal bones in the forefoot, in the heel bone, and in the tibia (leg bone).
Structural Deformity: Stress fractures due to structural deformities are more common in the tibia and second metatarsal. When the ankle has an inner twist (varus) the talus in the ankle hits the tibia and causes a small crack. This crack if untreated can lead to a displaced fracture and arthritis in the ankle joint. Second metatarsal stress fractures can also occur when the metatarsal itself is very long and associated with a bunion deformity. The long second metatarsal takes on more of its share of body weight and cracks can develop, especially in an unconditioned athlete or when performing an exercise that a person is unaccustomed to over a period of days. They can also occur in women who wear high-heeled shoes and are not accustomed to it and put stress on the second metatarsal bone.
Pathological Stress Fractures: These types of stress fractures occur due to an underlying bone condition causing weakness to the bone, which may eventually result in a stress fracture due to the bone’s inadequacy to support daily activities. Individuals with osteoporosis most commonly encounter these types of stress fractures. Other systemic conditions and certain medications can also cause demineralization of bone, which predisposes an individual to a stress fracture. On rare occasions, a bone tumor may be present, which may also result in a pathologic stress fracture of a bone.
Symptoms: The most common symptom is a dull aching type of pain well localized to a specific area in the lower extremity. The condition is usually exacerbated by the increase in weight-bearing and walking-type activities. Pain is decreased with rest and a decrease in activity level. The onset of symptoms is usually gradual and nonspecific. Often when unrecognized, individuals may experience compensatory pain in other areas, trying to avoid the area of initial pain.
Signs: Pain with direct pressure to the area as well as with ambulation. Pain is worse with an increase in activities and decreases with rest and a decrease in activities. Local swelling with mild discoloration in the area may be seen. When it occurs early it may be subtle. However, when the bone is fractured the swelling and the pain increase.
X-rays: Initially x-ray findings are negative and a diagnosis is made on the patient’s history and the physician’s clinical evaluation. Radiographic signs of a stress fracture may not appear for up to 21 days after the initial onset of symptoms. When a fracture callus develops it is easily seen on the x-ray and is an indication that the fracture is healing.
Overuse Injury: Overuse injuries are the most common type of stress fracture encountered in our practice. This type of stress fracture occurs due to overuse and an increase in demand on a particular bone in the lower extremity. An overuse stress fracture either occurs in athletes (i.e. running, aerobics) who consistently place stress in a particular area of the lower extremity until the bone fatigues due to over demand or when an individual begins a particular exercise (i.e. walking) and begins to place stress in a particular area that has not been properly conditioned. These types of stress fractures usually occur in the metatarsal bones in the forefoot, in the heel bone, and in the tibia (leg bone).
Structural Deformity: Stress fractures due to structural deformities are more common in the tibia and second metatarsal. When the ankle has an inner twist (varus) the talus in the ankle hits the tibia and causes a small crack. This crack if untreated can lead to a displaced fracture and arthritis in the ankle joint. Second metatarsal stress fractures can also occur when the metatarsal itself is very long and associated with a bunion deformity. The long second metatarsal takes on more of its share of body weight and cracks can develop, especially in an unconditioned athlete or when performing an exercise that a person is unaccustomed to over a period of days. They can also occur in women who wear high-heeled shoes and are not accustomed to it and put stress on the second metatarsal bone.
Pathological Stress Fractures: These types of stress fractures occur due to an underlying bone condition causing weakness to the bone, which may eventually result in a stress fracture due to the bone’s inadequacy to support daily activities. Individuals with osteoporosis most commonly encounter these types of stress fractures. Other systemic conditions and certain medications can also cause demineralization of bone, which predisposes an individual to a stress fracture. On rare occasions, a bone tumor may be present, which may also result in a pathologic stress fracture of a bone.
Symptoms: The most common symptom is a dull aching type of pain well localized to a specific area in the lower extremity. The condition is usually exacerbated by the increase in weight-bearing and walking-type activities. Pain is decreased with rest and a decrease in activity level. The onset of symptoms is usually gradual and nonspecific. Often when unrecognized, individuals may experience compensatory pain in other areas, trying to avoid the area of initial pain.
Signs: Pain with direct pressure to the area as well as with ambulation. Pain is worse with an increase in activities and decreases with rest and a decrease in activities. Local swelling with mild discoloration in the area may be seen. When it occurs early it may be subtle. However, when the bone is fractured the swelling and the pain increase.
X-rays: Initially x-ray findings are negative and a diagnosis is made on the patient’s history and the physician’s clinical evaluation. Radiographic signs of a stress fracture may not appear for up to 21 days after the initial onset of symptoms. When a fracture callus develops it is easily seen on the x-ray and is an indication that the fracture is healing.
Severe sudden onset pain especially with the first step out of bed in the morning is usually plantar fascitis. In the short term put your best pair of shoes right next to the bed and put them on before you put any weight on your feet. Then get to a foot doctor and get the right diagnosis.
I recommend you make an appointment with a foot and ankle surgeon (podiatrist) for diagnosis, cause and treatment options for your case. A stress fracture is unlikely but an x ray will be a good start
Thanks for sharing your foot concern with the FATD community. I am sorry to read about this. I would be happy to offer you my thoughts, tips, and suggestions. Many of my thoughts around people and their musculoskeletal problems or concerns are influenced by a thorough history. If you are in good health and have a good history of weight-bearing activities and exercises, regular menses, and no family history of osteoporosis, then it is not likely that you have a stress fracture. However, if you exercise too much for your body, have irregular menses, and had some pain in that area over the last several weeks, then the possibility of a stress fracture increases. Without a big traumatic event and immediate onset of pain, it is not likely that you acutely broke a bone in your foot.
What type of shoes were you using when you went for a walk? I hope they were supportive sneakers of some sort. What were you walking on? Asphalt, cement, and concrete are more detrimental than grass or a cushioned track or treadmill. How long was the walk? Did you stretch or take your ankle through a full range of motion before and/or after the walk?
I am thinking it is more of a stress reaction than that of a fracture. You may have over-impacted the surfaces of the bones in the outside aspect of your left foot. Therefore, it is as if you bruised this area. I am an advocate of an anti-inflammatory (as long as your doctor is OK with them, and you do not have a history of stomach problems or gastritis) with food, and see how it goes. Obviously, do not try and run, jump, stair-climb repetitively, or hop on it (and would even avoid walking for exercise for the next 2-3 days, until you feel better) until it feels better.
I hope this helps and I hope you feel better soon.
What type of shoes were you using when you went for a walk? I hope they were supportive sneakers of some sort. What were you walking on? Asphalt, cement, and concrete are more detrimental than grass or a cushioned track or treadmill. How long was the walk? Did you stretch or take your ankle through a full range of motion before and/or after the walk?
I am thinking it is more of a stress reaction than that of a fracture. You may have over-impacted the surfaces of the bones in the outside aspect of your left foot. Therefore, it is as if you bruised this area. I am an advocate of an anti-inflammatory (as long as your doctor is OK with them, and you do not have a history of stomach problems or gastritis) with food, and see how it goes. Obviously, do not try and run, jump, stair-climb repetitively, or hop on it (and would even avoid walking for exercise for the next 2-3 days, until you feel better) until it feels better.
I hope this helps and I hope you feel better soon.
Very possible, need to go to a podiatrist for evaluation and possible x-rays.
A stress fracture is part of the differential diagnosis in this case, but is not the likely problem. On the lateral side of the ankle, the list of differentials is plantar fasciitis, Peroneal tendinitis, Calcaneal stress fracture, neuritis. Not a whole lot more in the differential
Unlikely but possible. If still hurts over the next few days get it looked at.
Anything including a stress fracture is possible. If rest ice compression and elevation are not helpful you need to see a doctor who can perform a physical exam and take X-rays to determine an appropriate treatment plan.
It is possible you have a stress fracture of the base of the fifth metatarsal.
Robert D. Swift, DO, FAOAO
Orthopedic Surgeon, Board Certified
Robert D. Swift, DO, FAOAO
Orthopedic Surgeon, Board Certified
