Stress fractures of the heel I. Etiology and pathology Stress fractures of the heel are uncommon. They usually occur in workers who suffer repeated high stresses on the heel and in soldiers after prolonged military training. Symptoms and diagnosis Diffuse pain in the heel, mild swelling in the heel, and sometimes ecchymosis. There is pressure pain on both the medial and lateral sides of the heel, not just limited to the metatarsal side. X-ray: early normal, after 3-4 weeks a sclerotic zone can be seen on the lateral aspect of the heel bone from posterior inferior to anterior inferior. Isotope scan: increased local resorption is seen in the early stage. Treatment: Local use or oral anti-inflammatory and pain-relieving drugs. Reduce activity, walk with crutches, and reduce plantar weight-bearing. Heel pad protection.