Stress Fractures

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What are stress fractures?

A stress fracture is a small crack in a bone. It is a form of overuse injury from repetitive stresses on the bone. The weight-bearing bones of the lower leg and foot are the most common places to sustain a stress fracture. In fact, more than half of all stress fractures affect the lower leg and foot. These bones and the muscles that support them constantly bear your body weight and absorb the forces of walking, running, jumping, and other activities. When the supporting muscles fatigue, they transfer the force to the bones. This adds stress and can cause a crack to develop.

Common stress fractures include:

  • Calcaneal stress fracture, which is a stress fracture of the heel bone (calcaneus)

  • Navicular stress fracture, which is a stress fracture in the top of the foot in the midfoot area. It affects the navicular bone, which sits in front of the ankle.

  • Foot stress fracture, which can affect any of the 26 bones of the foot. Stress fractures in the foot include calcaneal and navicular stress fractures.

  • Stress fracture in the shin, which affects the shinbone (tibia). The symptoms are similar to shin splints.

Stress fractures and other overuse injuries are common in people who play sports and participate in other recreational activities. Stress fractures are one of the most common sports injuries. However, people who perform repetitive activities for work are also at risk for these injuries.

If you are at risk for this type of injury, be alert for signs of a stress fracture. A red flag is pain that occurs with activity and subsides with rest. It’s important to seek prompt medical care if you experience this type of pain. You will need imaging exams to confirm the diagnosis and gauge the extent of the injury. Continuing to be active and put stress on the bone can result in a complete fracture or broken bone.

What are symptoms of stress fractures?

Pain is the most common symptom of a stress fracture. The pain typically starts gradually. For a lower leg or foot stress fracture, it occurs with weight-bearing activities and can worsen over time. Resting or stopping the aggravating activity will ease the pain. Other stress fracture symptoms include swelling and tenderness in the area.

The symptoms of a stress fracture are similar to other types of overuse injuries. Stress fractures can often be diagnosed by means of the clinical history and physical examination. If necessary, your doctor will use imaging exams to determine if you have a stress fracture and rule out other injuries.

Do not delay if you suspect you may have a stress fracture. Seeking medical care early after symptoms begin generally results in a better outcome. The sooner you get an accurate diagnosis and allow the bone to heal, the sooner you will be back to an active lifestyle.

What causes stress fractures?

Stress fractures tend to occur after a sudden increase in your activity level. This could be more frequent activity, longer duration of activity, or higher intensity of activity. Any of these increases can contribute to the muscle fatigue that transfers added stress to the bones.

What are the risk factors for stress fractures?

There are a number of factors that can contribute to a stress fracture, including:

  • Changes in surface, which alters the forces on your bones. Examples include moving from turf to grass or a treadmill to pavement.

  • Osteoporosis, which thins and weakens the bones. This makes them unable to withstand even normal stresses. Stress fractures can occur with daily activities.

  • Poor conditioning, or doing too much too soon. This can include people starting an exercise or activity for the first time. It can also include athletes beginning a season too vigorously without giving their bodies time to adjust. Adequate periods of rest are important to allow the body to heal and adapt.

  • Poor technique, which often results from something that interferes with proper foot or leg mechanics. Compensating for another injury, such as tendinitis, can change the way your foot absorbs stress. This change increases the risk of a stress fracture.

  • Worn out or improper equipment, which can’t support the bones and muscles the way they should. Shoes that no longer have adequate cushioning no longer protect the bones and muscles from stress. Improperly fitting shoes can also change the mechanics of the foot or leg.

Reducing your risk of stress fractures

You may be able to lower your risk of developing a stress fracture by:

  • Balancing cardiovascular, strength and flexibility exercises

  • Cross-training with a variety of sports and activities

  • Scheduling periods of rest and time off from physical activities

  • Slowly increasing activities to allow your body to adapt

  • Taking time to warm up and cool down after physical activity

  • Using the right equipment with the proper fit

If you could be at risk of a stress fracture, talk with your doctor about your activities. Ask about strategies specific to you and your activity that can help you avoid a stress fracture and other overuse injuries.

How are stress fractures treated?

The goal of stress fracture treatment is to heal the bone. This starts with stopping the aggravating activity and resting. It can take time, up to eight weeks, for the bone to heal properly. To aid recovery, your doctor may recommend RICE (rest, ice compression and elevation). This will help relieve symptoms as well. Your doctor may also ask you to use a special shoe insert, walking boot, or crutches to keep weight off the bone. Your doctor may allow no-impact activities, such as swimming or cycling, during this time. In some cases, a cast may be necessary, which would eliminate even these activities. If the bone fails to heal, surgery may be the next step.

What are the potential complications of stress fractures?

Stress fractures usually heal with adequate rest and treatment. However, complications can occur if you continue to push through the pain or do not allow enough time to heal before returning to activities. This includes nonunion, or incomplete healing, and malunion, or abnormal healing. These can result in chronic pain and disability. You could also end up with a complete fracture or repetitive fractures.

When stress fractures continue to occur, osteoporosis may be the cause. Your doctor should evaluate your bone density and begin treatment if necessary. The best way to avoid the other complications of a stress fracture is to closely follow your treatment and recovery plan.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 26
  1. Overuse Injury: How to Prevent Training Injuries. Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/overuse-injury/art-20045875?pg=1
  2. Stress Fractures. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures/
  3. Stress Fractures of the Foot and Ankle. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures-of-the-foot-and-ankle/
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