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Stress Fracture

Definition

A stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.

Stress Fractures of the Tibia and Fibula
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Causes

A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:

  • Increasing the amount or intensity of an activity too quickly (most common)
  • Switching to a different playing or running surface
  • Wearing improper or old shoes

Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

Risk Factors

Stress fractures are more common in women. Other factors that may increase your chance of a stress fracture include:

  • Sports that involve running and jumping, such as:
    • Tennis
    • Track, especially distance running
    • Gymnastics
    • Dance
    • Basketball
  • Absense or early stopping of menstrual cycle—amenorrhea
  • Reduced bone thickness or density—osteoporosis
  • Poor muscle strength or flexibility
  • Overweight or underweight
  • Poor physical condition

Symptoms

A stress fracture may cause:

  • Localized pain on the bone
  • Pain when pressure is applied directly over the fracture and the area around it
  • Pain when putting stress on the affected leg
  • Swelling and warmth at injury site

Diagnosis

The doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling.

Imaging tests to evaluate your bones include:

  • X-rays—stress fractures are very tiny and usually not seen on an x-ray until at least 2 weeks after symptoms begin
  • MRI scan
  • Bone scan

Treatment

Treatment includes:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.

Rest

Rest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks.

Crutches or a Cane

You may need crutches or a walking cane to keep pressure off the leg.

Activity

Talk with your doctor about when you can restart activity and how to progress with the amount and type of activity.

A common progression:

  • Begin with nonweight–bearing activities, such as swimming or bicycling.
  • Next, you can do weight-bearing, nonimpact exercise, such as a stair machine.
  • Gradually, you will be able to add low-impact activity, starting with walking.
  • Once you can do fast-paced walking with no pain, you can start higher impact activity, such as light jogging.
  • This gradual progression continues until you have reached your pre-injury activity level. You can return to full activity once you do not feel tenderness of the bone.

Prevention

To help reduce your chance of a stress fracture:

  • Gradually increase the amount and intensity of an activity
  • Run on a softer surface, such as grass, dirt, or certain outdoor tracks
  • Do not overdo any activity
  • Wear proper footwear
  • Maintain a proper weight
  • Avoid smoking

Revision Information

  • American Orthopaedic Society for Sports Medicine

    http://www.sportsmed.org

  • Ortho Info—American Academy of Orthopaedic Surgeons

    http://www.orthoinfo.org

  • Canadian Orthopaedic Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • Femoral stress fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2012. Accessed September 29, 2014.

  • March fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed September 29, 2014.

  • Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med. 2001;11:73-76.

  • Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68(8):1527-1532.

  • Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 29, 2014.

  • Wells CL. Women, Sport & Performance: A Physiological Perspective. Champaign, IL: Human Kinetics; 1991.

  • Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39:65-69.