Throughout the day, our feet are the recipients of constant pounding and stress. Whether from the hard pavements of the streets or cramped conditions of work heels or dress shoes, our feet frequently take a good beating. Dramatic daily overuse can occasionally cause fractures in our feet called stress fractures. Stress fractures are the result of chronic overuse or repetitive force, which can lead to small hairline cracks in the bones of the foot.

The most common sites of these stress fractures are in the weight bearing bones of the feet. In my office, I frequently see stress fractures on the metatarsals, which are the long bones in the middle of the foot. However, they are also common on the heel and the midfoot bones. Here are some of the reasons fractures like this occur.

Increase in impact. While these injuries are more common in athletes, any high-impact activity will add foot stress. Anyone starting a new exercise regimen, including any increase in frequency, duration, or intensity of an activity, is at risk. This also includes inadequate conditioning. The muscles in your feet need time to strengthen and adapt to the new pressures exercise brings. Too much activity too quickly will result in muscle fatigue and can eventually cause fractures or breaks in the bone.

Improper shoes. It sounds unlikely, but fractures from improper footwear are more common than most would think. Shoes that lack padding or are too stiff can lead to symptoms of chronic overuse. High heels can also cause stress on the ball of the foot, leading to stress fractures of the metatarsals. Podiatrists recommend wearing a different pair of shoes every day and also wearing walking shoes for the daily commute, changing into office shoes upon arrival. Hard pavement can lead to stress on the feet, so soft, padded shoes should be worn whenever on these surfaces.

Change in walking pattern. Any injury to the lower extremity can alter walking patterns. For example, if one has sustained an ankle sprain, tendon injury, or a bunion, walking may be altered to avoid pain on the injury site. This can change the biomechanics during the gait cycle, putting new stress on previously unloaded parts of the foot. This compensation may eventually result in a fracture.

Weakened bones. Reduced bone density seen in older individuals can result in fractures. A discussion with your doctor about your risk factors and a bone density test can determine if you are prone to these injuries. Women with abnormal or absent menstrual periods are at risk, as well as those suffering from osteoporosis. Patients with low body weight, and low calcium levels also may be more at risk for injury.

Because these fractures typically occur without a traumatic incident and because the associated pain symptoms can sometimes be vague, many patients delay seeing their foot doctors. Delayed diagnosis can lead to delays in healing time. If you are experiencing any pain, it is best to see your podiatrist as soon as possible to avoid complication and further injury.