Stress Fracture

What is a stress fracture?

A stress fracture is a small crack in a bone. These fractures are most often a result of overuse and are commonly seen with an increase in activity. Stress fractures occur most commonly in the weight-bearing bones of the legs. When these bones are subjected to a new stress, such as a new exercise routine, they may not be well adapted, and as a result they may crack under the new stresses being applied. 

What are the symptoms of a stress fracture? 

The symptoms of stress fractures can vary widely. However, the most common complaint is pain. The pain may develop gradually and often is relieved by rest. Pain usually becomes more intense with physical activity and can be associated with swelling. Swelling and tenderness may be present in the area of pain. It is rare to see bruising or discoloration. 

What causes a stress fracture?

​Overuse is the first cause of stress fracture. This may be confusing, but overuse could simply mean a change in activity. An increase in exercise, athletics, job duties or even shoewear can bring on a stress fracture. Some patients even report stress fractures after a simple change like going on a vacation where an unusual amount of walking was done.

Other risk factors include certain sports that have a high frequency of repetitive activity. In particular running and jumping sports may cause stress fractures.

Osteoporosis may also place a patient at risk for stress fracture. Weak or soft bones may not be able to handle even the simplest of changes in activity and develop stress fractures. Any bones of the feet or ankles can be affected by a stress fracture. 

How is a stress fracture diagnosed?

​After taking your medical history, your doctor will examine your foot. A series of X-rays is usually ordered. If the crack is small, or you've only had symptoms a short time, the X-rays may be normal. So if needed, additional imaging by CT scan, nuclear bone scan or MRI could be ordered.   

What are treatment options?  

​Since stress fractures most often occur as a result of overuse, the first treatment includes stopping the activity that brought on the fracture. A period of rest is needed. Taking time away from the activity may be needed for six to eight weeks. Usually exercise can continue, but a low-impact form of exercise such as swimming, elliptical trainer or exercise bike is recommended.

Additional measures such as shoewear modification may be prescribed. A stiff shoe insert or bootwalker can be part of the treatment. And in certain cases, your doctor my recommend a cast or crutches. Calcium and vitamin D supplements often are prescribed.​

Most stress fractures will heal with the conservative measures outlined above, but there are instances when surgery is needed. The most common situation that requires surgery is when the bone fails to heal, which is called a nonunion. Surgery would usually include placing screws to secure the bone. Sometimes this surgery also includes placing fresh bone into the area that is slow to heal. This process is called bone grafting. 

Potential Complications 

The most common complication that occurs with stress fracture is nonunion. Other complications include malunion (healed bone but in a abnormal position), and recurrent fractures. Recurrent fractures typically occur if the underlying problem is osteoporosis. There are medications that may be able to be prescribed if the osteoporosis is severe.  

Frequently Asked Questions 

How can I prevent stress fractures?

  • Select the proper footwear for the specific type of exercise
  • Start out slowly when beginning an exercise program following a layoff period
  • Walk and stretch to warm up gradually before running or walking
  • Focus on stretching and strengthening the muscles in the calf
  • Increase running or walking distance and speed gradually, in increments no greater than 10 percent per week
  • Avoid unaccustomed strenuous sprinting
  • Take the time to cool down properly after exercise​ 

Additional Resource  

Talus Fracture 

This material was codeveloped by the American Academy of Orthopaedic Surgeons. ​

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