Running-related Bone Stress Injuries Not to be Missed - Part 2

In part one we covered high‑risk sites around the hip, pelvis and shin. Here are foot and heel bone stress injuries that are commonly missed.

Common foot and hindfoot sites

• Metatarsal shaft — the long bones of the forefoot (especially the 2nd and 3rd metatarsals) are frequent stress sites and can be misdiagnosed as metatarsalgia or Morton’s neuroma.

• Metatarsal base — the base of the 5th metatarsal (Jones region) is high risk and needs specific management. High risk.

• Navicular — a midfoot bone often mistaken for a midfoot sprain. Central third navicular stress injuries have poor healing capacity and usually require early non‑weight bearing and advanced imaging. High risk.

• Sesamoids — small bones under the big toe can progress from overload to true stress reaction; these are high risk for prolonged symptoms.

• Calcaneus — heel bone stress can mimic plantar fasciopathy or Achilles tendinopathy; it may occur from overuse as well as acute trauma.

Red flags and management essentials As with other sites, suspect bone stress when there is focal bone tenderness, a sudden training increase, or low energy availability. Management ranges from load reduction to complete non‑weight bearing depending on severity and site. Many of these injuries do not appear on X‑ray — MRI or CT is usually required for early diagnosis. If you suspect a bone stress injury in your foot or heel, get it checked promptly to reduce the risk of progression.

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