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What Is a Stress Fracture?

Stress fractures are among one the most common sports injuries. In short, these types of fractures typically occur in very small bones after abnormal or repeated stress.

Many times, stress fractures go unnoticed. Some may complain of a deep soreness in the foot during exercise but think nothing more about it after the activity is over.

However, over time stress fractures can become worse. If left untreated, it can lead to serious complications down the road.

What Are Stress Fractures?

Maybe you’ve felt it before — a deep, dull pain or soreness in your foot growing worse after workouts. If so, you could’ve had a stress fracture. Stress fractures are hairline cracks in the bone.

Unlike sprains or other bone fractures that require immediate urgent care, stress fractures are easy to ignore since they typically get worse during high-impact exercise and resolve during times of rest.

Stress fractures are considered an overuse injury caused by repetitive activities. For example, the majority of stress fracture injuries are due to running sports, especially long-distance endurance runners.

What Causes Stress Fractures?

Stress fractures are typically caused by repetitive, high-impact movements that are common in high-impact sports training. However, nutritional factors and certain medical conditions may also contribute to stress fractures.

Repetitive stress coupled with increasing workout intensity too quickly can result in this overuse injury. Similar to our muscles, bones also require an adapting period when confronted with increased loads.

This is known as bone remodeling. It occurs naturally during times of bone growth, mechanical stress, and fractures. Bone tissue is resorption and replaced. However, when bones are unaccustomed to a certain level of intensity or repetitive force, stress injuries to the bones can occur.

What Are the Risk Factors for Stress Fractures?

Certain risk factors contribute to stress fractures. These are generally divided into two categories: Extrinsic and intrinsic factors.

Extrinsic Risk Factors

Extrinsic risk factors are factors that occur outside of the body. Common extrinsic factors that can increase the risk of stress fractures include:

Most stress fractures occur from repeated motions during high-impact sports. These include track and field, gymnastics, dance, basketball, long-distance running, tennis, strength training, and more.
Practicing with poor equipment or wearing the wrong footwear, like running shoes that are too loose, too rigid, or worn out.
Increasing activity level too rapidly, using improper technique or incorrect training methods.
Type of environment you train in — e.g., running on sloped surfaces or surface changes (soft to rugged).
Poor or inadequate nutrition, including insufficient calcium and vitamin D intake or caloric insufficiency.

Intrinsic Risk Factors

These refer to things that are not impacted by outside factors. These are risk factors that are unique to the individual. Common intrinsic factors considered high risk for stress fractures include:

Anatomy can be an issue. For example, those with high arches or flat feet may be more susceptible to stress fractures.
Age and weight. Some individuals may have weakened bones due to age and conditions like osteoporosis, making stress fractures more common. Also, those who are underweight and have a low BMI are more prone to stress fractures.

Female athletes can also be at a higher risk for developing stress fractures. The female athlete triad refers to three conditions that can contribute to stress fractures: Lack of proper nutrition or eating disorder, menstrual dysfunction, and low bone density.

What Are the Signs and Symptoms of Stress Fractures?

The symptoms of a stress fracture depend on the individual, location, and extent of the injury. Some may even be pain-free. But, in general, signs and symptoms of a stress fracture can include:

Discomfort or pinpoint tenderness when the bone is touched.
Aching, pain, or swelling at the site.
Pain or discomfort that begins with physical activity and decreases once it’s over.

Over time, pain can stick around even after the activity has stopped. Also, pain may start to occur during normal activities like walking or even at rest. In some cases, untreated stress fractures can worsen and require more immediate medical attention.

In some cases, stress fractures may even be confused with other injuries, such as muscle strains, ankle sprains, or tendon injuries.

Where Do Stress Fractures Occur in the Body?

Stress fractures can occur in the upper and lower body. However, they are much more common in lower extremity bones. This is especially true for load-bearing bones in the lower legs.

The bones that are most susceptible to stress fractures include the metatarsal bones. These include bones of the foot. Stress fractures are most common on the top of the foot, among the second and third metatarsals just behind the toes.

Stress fractures are also common in the tibia and fibula of the lower leg. The tibia, or shin bone, is the inner lower leg bone, and the fibula is the outer.

The ankle joint (talus), heel bone (calcaneus), and navicular (where the top of the foot meets the ankle) are also susceptible to stress fractures.

While it is certainly possible, stress fractures are far less common in the upper leg bones, like the femur or areas around the pelvis.

Stress fractures in the upper body — wrists, arms, shoulders, etc. — can also occur. But, they are also far less common and are typically associated with bone density issues like osteoporosis.

How Are Stress Fractures Diagnosed?

Stress fractures require a diagnosis by a medical provider. Several tests may be required in order to diagnose. A physical examination is step number one.

In addition to a physical exam, a thorough medical history and detailed history of exercise activities should be expected.

X-rays are also used to help diagnose stress fractures. Sometimes, a stress fracture may not appear on an x-ray. So, more intensive procedures like CT scans, a magnetic resonance imaging (MRI), or a bone scan may be required to diagnose.

What Are Prevention and Treatment Options for Stress Fractures?

Some easy ways to help avoid and prevent stress fractures include:

Maintaining a healthy diet, making sure to include calcium-rich foods and vitamin D.
Using the proper equipment. Throw away old and worn-out running shoes that offer no support.
Set achievable, incremental goals. It is important to build up to fitness goals. Too much too soon can lead to injuries like stress fractures, broken bones, or worse.
Try cross training. This may include running with a combination of strength training to add flexibility to your fitness regimen.

Treatment for stress fractures depends entirely on the extent of the injury. In many cases, rest is enough to help the hairline cracks heal. That means taking time off from your sports activity.

Regularly icing the area can also be helpful. For some, physical therapy with a sports medicine specialist or more intensive orthopedic care may be required. In severe cases, surgery may be required for treatment.