Stress fractures of the calcaneus, or heel bone, occur due to repetitive stress that overwhelms the bone's capacity to repair itself. This injury is most common in athletes, military recruits, and individuals involved in high-impact activities. 

At Palms Physiotherapy & Allied Health, we specialise in managing and rehabilitating calcaneal stress fractures to help you regain mobility and prevent recurrence.

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.

Australian Resources for Calcaneal Stress Fractures

• Healthdirect Australia – Bone Stress Injuries
  https://www.healthdirect.gov.au/bone-stress-injuries

• Better Health Channel – Foot and Ankle Injuries
  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/foot-and-ankle-injuries

• Sports Medicine Australia – Injury Prevention Resources
  https://sma.org.au/resources-advice/injury-prevention