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
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
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.
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
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
This material was
codeveloped by the American Academy of Orthopaedic Surgeons.
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.