It Started As A Niggle In The Foot
She was just like so many of the runners we see at the clinic. Active, motivated, and training for something she cared about. For her, it was a local half marathon. A couple of months out from race day, she started to notice a dull ache along the outside of her foot after her runs. Nothing dramatic. Just a bit sore the next morning, maybe slightly stiff. It would settle in a day or two, so she kept going.
But gradually, it became more noticeable. What once faded overnight started to linger. The ache turned into a sharper pain that flared up halfway through a run. It would still calm down with rest, but it kept coming back. She assumed it was just one of those typical training pains, maybe a tight muscle or a bit of overuse. And like many runners, she pushed through it.
When Rest Isn’t Enough
By the time she came to see us, she had already seen her GP. The X-ray looked fine, so she was told to take it easy for a week and then carry on. But she knew something still wasn’t right. She described a deep, localised pain in the middle of her foot, right near the second metatarsal. It ached during runs and throbbed at night. Some days there was a hint of swelling, even when she had done very little.
We hear this story far too often. Many stress fractures in the foot simply do not show up on an X-ray. That does not mean there is nothing wrong. Her symptoms matched the pattern of a stress fracture almost perfectly. She had gone from early warning signs to a full fracture because no one had caught it in time.
We referred her for an MRI, and sure enough, it showed a clear stress fracture in the second metatarsal. She had been running on it for weeks without realising what was really going on.
The Frustrating Truth About Stress Fractures
Stress fractures are one of the most underdiagnosed injuries in active people. They often begin with a “stress response,” which is the body’s way of saying it is under too much load and needs help recovering. At that point, the bone is irritated but not broken. If caught early, treatment is often straightforward and may not even require stopping sport completely.
But most people ignore those early signs. They think it is just tightness or a sore muscle. The pain might only show up after exercise, then slowly creep into the workout itself, and eventually into rest. By the time it becomes clear that something is wrong, it is usually a full-blown stress fracture that requires several weeks off to heal.
In the foot, the most common spots are the second and fifth metatarsals, the heel bone, and the midfoot bones like the navicular. Any sharp or localised pain over these areas deserves attention, especially if it is persisting or worsening.
What To Look Out For
There are three key symptoms that people often overlook. The first is swelling. Even minor puffiness around the foot that comes and goes can be a red flag. The second is night pain. If the pain is waking you up or flaring when you are not using the foot, it is time to investigate. The third is any pain that sticks around longer than expected after a run or feels more like bone than muscle. That kind of pain should not be pushed through.
In this case, if we had caught the stress response earlier, she might have avoided the fracture completely. She might not have needed time off from running at all. Instead, we could have adjusted her training, added some targeted rehab, and helped her stay on track safely. That is the power of early intervention.
Healing and Moving Forward
Once we had a clear diagnosis, her treatment was straightforward. A period of relative rest, some load management strategies, and a carefully structured rehab plan got her back on her feet. It took time, but she recovered fully and eventually returned to training with a much better understanding of how to listen to her body.
We see this all the time. Pain in the foot gets dismissed as something minor, and by the time it is taken seriously, the damage has been done. If you are a runner or someone who spends a lot of time on your feet and you notice persistent pain, especially the kind that feels deep or comes with swelling or night aches, do not wait. It is always worth having it checked out by someone who understands bone stress injuries. The sooner we catch it, the easier it is to treat.
Joe Sharp
BSc (Hons) Physiotherapy
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