Updated Oct. 17, 2019
Stress fractures are some of the most common injuries that occur in athletes. These overuse injuries, which are small cracks in the bone, occur primarily in the lower leg and foot and are typically caused by repetitive use or a rapid increase in one’s amount of activity.
The most common complaint associated with these fractures is pain in the foot or leg with increased activity. Typically, this pain goes away when resting, but not always. Other symptoms may include tenderness and swelling.
Aaron Mares, MD, primary care physician, answers some of the common questions about stress fractures.
What Causes Stress Fractures?
The following could also cause stress fractures:
- Running and jumping
- Poor running technique
- Poor footwear
- Training changes (including a change in exercise frequency, duration, and intensity)
Who Is at Risk for Stress Fractures?
There are several different causes for stress fractures, and a combination of factors can put you at risk. Those include:
- Type of sport or activity: High-impact exercises and sports can lead to a higher risk of stress fractures. Those include sports like track and field, tennis, gymnastics, and basketball. The type of sport also can determine what type of stress fracture you develop. For example, rowers are more at risk of rib stress fracture and baseball players are more at risk of stress fractures in the upper arm.
- Changing routine: A difference in training intensity, duration, or number of sessions can put you at a higher risk.
- Poor equipment: This occurs mostly with lower leg and foot stress fractures. Wearing shoes that don’t offer proper support can put greater strain on your leg and put you at risk for stress fracture.
- Training surface: The type of surface you work out on can put you at risk. Uneven or hard surfaces can put more impact on your bones. However, running or training on more “giving” surfaces such as sand can increase muscle fatigue.
- Skeletal problems: Factors such as low bone density or poor bone alignment can put you at risk.
- Poor physical fitness: Studies have found people with low aerobic fitness levels are more at risk of stress fractures.
- Gender: Females are more at risk of stress fractures than males.
- Lack of nutrients: Dietary problems, such as a lack of calcium, can put you at risk.
- Age: Older adults and younger children could both be more at risk for stress fractures because their bone strength isn’t at its peak.
How Are Stress Fractures Diagnosed?
To diagnose, your doctor will perform an exam and will usually obtain an x-ray, or even an MRI. Once diagnosed with a stress fracture, it’s recommended that you rest from the activity that causes pain. Depending on the severity of the fracture, sometimes your doctor will recommend wearing a brace or boot to help with proper healing. As with other injuries, the best form of treatment is often prevention.
How Are Stress Fractures Treated?
Many stress fractures can go away by following the RICE protocol, which includes:
- Rest: Do not participate in any activities that will put stress on your injury. If you do have to bear weight, use a supportive shoe.
- Ice: Use cold packs immediately to keep the swelling down. Apply several times a day for 20 minutes to half an hour.
- Compression: Wrap your injury in a bandage to prevent more swelling, but don’t make it too tight.
- Elevation: Rest with your leg higher than your heart as much as you can.
In addition to the RICE protocol, several other treatments can help with stress fractures:
- Medication: Anti-inflammatories like ibuprofen can help with pain and reduce swelling, but these medications should be taken in moderation, as prolonged use may affect bone healing.
- Protective footwear: Doctors may recommend footwear that puts less stress on your lower extremities. These could include shoe inserts, stiff-soled shoes, wooden-soled sandals, or even a walking boot.
- Cast: Depending on where your fracture is, you may need a soft cast. This can help keep your bones in place, putting less stress on them.
- Surgery: Although rare, some stress fractures do need surgery to heal. Surgeons use pins, screws, and plates to hold bones together.
Recovery from stress fractures generally takes about six weeks to eight months.
Are Stress Fractures Preventable?
Stress fractures are overuse injuries, and if measures aren’t taken to prevent future ones from developing, they may return. To help avoid developing stress fractures:
- Scale up new activities in increments. Proper training and conditioning are essential.
- Eat a healthy diet. Calcium and vitamin D can help strengthen your bones.
- Wear proper-fitting equipment. While they can be pricey, shoes that fit properly and have the right insoles for your feet can help reduce injury.
- Avoid overuse. If you begin to feel pain, don’t continue to play through it; take a rest and slowly work your way back.
- Try cross-training. Varying your exercises can help keep you from putting too much stress on one part of your body. Pairing running with a lower-impact cardio workout like biking or swimming would be one example.
- Do strength training workouts. You can build stronger muscles and overall strength with strength training. You can use equipment like weights or resistance bands, or even your own body.
- Watch where you’re working out: You should change up the surfaces you work out on. If you work out mainly on hard surfaces like asphalt, try to get in some workouts on softer ground as well.
- Warm up. Try stretching before your run. Don’t go into it cold.
- Fix your biomechanics. Some overuse injuries like stress fractures are caused by abnormalities in your anatomy. Surgery can help correct those abnormalities and prevent injury.
If you suspect you have a stress fracture or another injury, please consult your doctor. To schedule an appointment with a UPMC orthopaedic specialist, call 412-687-3900.
Sources reviewed for this article
American Academy of Orthopaedic Surgeons, Stress Fractures of the Foot and Ankle (https://orthoinfo.aaos.org/en/diseases–conditions/stress-fractures-of-the-foot-and-ankle/)
American Podiatric Medical Association, What Is a Foot or Ankle Sprain or Fracture? (https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=982)
Kim Bennell, Gordon Matheson, Willem Meeuwisse, Peter Brukner, Sports Medicine, Risk Factors for Stress Fractures (https://link.springer.com/content/pdf/10.2165%2F00007256-199928020-00004.pdf)
RA Gallo, M Plakke, ML Silvis, Sports Injuries, Common Leg Injuries of Long-Distance Runners: Anatomical and Biomechanical Approach (https://www.ncbi.nlm.nih.gov/pubmed/24179587)
Stuart J. Warden, PhD, PT, David B. Burr, PhD, Peter D. Brukner, MBBS, Current Osteoporosis Reports, Stress Fractures: Pathophysiology,
Epidemiology, and Risk Factors (https://link.springer.com/content/pdf/10.1007%2Fs11914-996-0029-y.pdf)