Explanation of Diagnosis

A stress fracture is a small crack in the bone caused by repetitive stress or overuse, rather than a single traumatic injury. It commonly occurs in the metatarsals (long bones of the foot), calcaneus (heel), or navicular bone. Symptoms include localized pain, swelling, tenderness, and pain that worsens with activity but improves with rest. Stress fractures are common in athletes, runners, military personnel, and those with osteoporosis or improper footwear.

Specific Work Modifications

• Avoid prolonged standing, walking, or weight-bearing on the affected foot.
• If possible, use crutches, a walking boot, or a supportive shoe as recommended by your doctor.
• Modify tasks to allow for seated work and limit excessive foot stress.
• Use cushioned shoes or orthotic inserts to absorb impact.
• Take frequent breaks to reduce strain on the foot.

Specific Activity Modifications

• Avoid high-impact activities such as running, jumping, or hiking on uneven surfaces.
• Modify workouts by switching to low-impact exercises such as swimming or stationary cycling.
• Wear proper footwear with arch support and shock absorption.
• Gradually return to activity once cleared by a doctor, following a structured rehab plan.

Recommended Supplements

• Calcium (1000-1200 mg daily) – Supports bone healing and strength.
• Vitamin D3 (1000-2000 IU daily) – Enhances calcium absorption for bone repair.
• Magnesium (300-400 mg daily) – Aids in muscle relaxation and bone health.
• Collagen peptides (10 g daily) – Supports bone and connective tissue repair.
• Omega-3 fatty acids (1000 mg daily) – Helps reduce inflammation and pain.

Recommended Nutrition and Hydration

Diet Recommendations:

• Bone-strengthening foods: Dairy products, leafy greens, almonds, salmon, and fortified cereals.
• Anti-inflammatory foods: Fatty fish (salmon, sardines), turmeric, berries, and walnuts.
• Protein-rich foods: Chicken, eggs, lentils, and dairy to support tissue repair.
• Limit processed foods, excess sugar, and carbonated drinks, which can weaken bones.

Hydration Tips:

• Drink at least 2–3 liters of water daily to support bone healing and circulation.
• Limit caffeine and alcohol, which can reduce calcium absorption.

Home Exercise Prescription

⚠ No weight-bearing exercises until cleared by your doctor. Initially, focus on gentle mobility and strengthening exercises while protecting the fracture.

Phase 1: Early Recovery (Weeks 1-4, Reduce Pain & Swelling)

1. Toe Wiggles & Ankle Pumps

1. • Move toes and ankles up and down to maintain circulation.
   • 10 reps, 2-3 times daily.

2. Non-Weight-Bearing Calf Stretch

1. • Sit and use a towel to gently pull your toes toward your shin.
   • Hold for 20-30 seconds, repeat 3 times per foot.

3. Seated Foot Alphabet Exercise

1. • Use your toes to "write" the alphabet in the air.
   • 1-2 times daily.

Phase 2: Strength & Balance (Weeks 4+, If Cleared for Weight-Bearing)

4. Towel Scrunches (Arch Strengthening)

1. • Place a towel on the floor and use your toes to pull it toward you.
   • 10 reps, 2 times daily.

5. Heel Raises (Once Pain-Free)

1. • Stand and slowly raise onto your toes, then lower.
   • 10 reps, 2 times daily.

6. Single-Leg Balance Exercise

1. • Stand on one foot for 15-30 seconds, increasing time as tolerated.
   • Repeat 2-3 times per leg.

⚠ Avoid running, jumping, or high-impact activities until fully healed (typically 6-8 weeks).

Helpful Books

1. "Strong Bones: The Ultimate Guide to Preventing and Treating Osteoporosis" – Pamela Wartian Smith, MD
2. "The Healthy Runner's Handbook: Injury Prevention & Recovery" – Jason Karp, PhD

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.