Stress Fractures Can End Your Hike. Here’s How to Avoid Them.

It’s not unusual for hikers to have achy and sore feet, but sometimes a sore foot can mean something more significant like a stress fracture. All hikers are susceptible to stress fractures, but long-distance hikers are particularly vulnerable.

With a stress fracture, the pain and discomfort can vary; you know something is not right but it’s hard to pinpoint exactly what it might be. When I thru-hiked the Pacific Northwest Trail this year, I met a very accomplished hiker who had completed hundreds of miles with this type of erratic foot pain. The pain was finally confirmed as multiple foot stress fractures, which, unfortunately, immediately ended their hike. Here’s what you need to know about stress fractures so you can stay on the trails as long as possible.

What is a stress fracture?

Logging miles on your local trails is a great way to stay in shape, but sometimes they can lead to unwanted injuries like stress fractures. Thru-hikers and dayhikers alike are susceptible to this painful injury, so it’s important to know their causes and typical symptoms.

Activities like hiking and backpacking cause repetitive loading that may leave you prone to stress fractures. Stress fractures take time. They don’t come from a single bad misstep or incident: They come from chronic, repetitive loading and stress. Think of stress fractures like an overuse injury, as they are quite similar. Overuse injuries occur from a rise in activity that is greater than the body’s ability to manage that increase in activity. 

Over time, when you work out beyond your body’s capabilities, the stress from that new level of activity is greater than what the tissues or bones can handle. As a result, the body isn’t able to fully recover and repair itself before the next day’s activity.

What causes stress fractures?

Most common stress fractures for hikers occur in the tibia, longer toe bones called metatarsals, and in more extreme cases, the bones in the mid-foot, and even the heel bone. There are numerous factors that can lead to stress fractures, so let’s dive in.

Foot shape is one such factor, particularly a high arch. If you have a high arch, you are more prone to placing stress through the metatarsals in your foot, which can trigger hairline fractures. In addition, if your second and third toes are longer than your big toe, that will place additional stress through these toe bones as you push off with each step. For this reason, second and third toe bones are some of the more commonly fractured toe bones.

Walking style, or gait, may also play a role. If you land on the outside of your foot and roll onto your sole as you walk, you’ll stress the fifth toe bone, which also is a common site for a fracture. There are other factors too, such as leg length discrepancy, where one leg is slightly longer than the other. Weak muscles can lead to fatigue that will place stress on high stress fracture prone regions too. Once the muscles become fatigued, they can no longer support ideal motion, which causes stress to bones and other tissues.

There are some additional factors such as footwear type, improper insoles, nutrition, pack weight, and terrain. 

Is it a stress fracture or something else?

If you suspect a stress fracture, it’s best to see a doctor. A quick visit will provide a clear diagnosis and management plan specific to your needs.

Stress fractures may present a few different ways: pain with walking, lingering swelling, tenderness, bruising, etc. They could also present as other issues like sprains, strains, shin splints, Morton’s neuroma, and even plantar fasciitis. However, in stress fractures, the pain often starts off as gradual and dull, and it might be hard to pinpoint a specific painful area. 

You might notice some swelling or tenderness as well, but things normally feel better with rest or with ibuprofen. Initially, the pain might be manageable and you’ll be able to continue hiking, albeit with more discomfort as the miles start to add up.

Get strong

Taking shorter strides is one of the simplest ways to help decrease stress through the toe bones. This allows your body to move more efficiently and absorb the ground reaction force more effectively. It’ll feel awkward at first, and you’ll naturally fall back into your normal walking stride. When you recognize you’re taking longer strides again, use that as your cue to return to short strides.

As hours and miles of hiking fatigue your muscles, you’re more susceptible to injuries. Proper training helps the body adapt to long-term activity. Progressive training hikes are a great way to slowly introduce miles and pack weight to the body without increasing injury risk. This will help in a couple ways. First, your body adapts to heavier pack weights and hiking longer distances. Secondly, the muscles that help to maintain good foot and ankle position get stronger. In addition to training hikes, a well-rounded lower leg and hip routine will help strengthen and build endurance in key muscle groups that also help with foot position.

Proper footwear selection and insoles can be valuable tools as well. If you’re not sure what’s best for you, go to a shoe store or specialist that will measure your feet or offer a gait assessment. Having the right shoe can make a huge difference in comfort and foot health.

Nutrition is also key, especially for long-distance hikers. Since it can be hard to eat healthy on a hike, emphasize the healthy options when available. Foods like yogurt with mixed berries or granola offer calcium, while egg yolks, fish, and milk provide vitamin D; all are great for building strong bones. Salads are a great way to mix in lots of vitamins and minerals that can also help with bone healing. When you get in-town burgers on your hike, make it a cheeseburger (for the calcium) and add a side salad (for the vitamin boost).