Stress Fracture
Also known as: Fatigue fracture, Hairline fracture, March fracture
A stress fracture is a tiny crack in a bone caused by repetitive force rather than a single injury. It develops when bone is loaded faster than it can repair itself, so it is most common in the weight-bearing bones of the lower leg and foot in runners, dancers, military recruits and athletes who have ramped up training quickly. Early on the pain is a dull ache during activity that goes away with rest, but if ignored the crack can deepen and even become a complete break. Weakened bone from low bone density, poor nutrition or hormonal problems makes stress fractures more likely. With appropriate rest, most heal fully in 6 to 8 weeks, though some sites heal slowly and need special care.
At a Glance
- Common symptoms
- Pain that develops gradually and worsens during weight-bearing activity, Pain that initially eases with rest but over time becomes constant, Tenderness when pressing on a specific spot on the bone
- Main treatments
- Rest from the activity that caused the fracture, usually for 6 to 8 weeks, with crutches or a walking boot for some sites, Pain relief with ice and acetaminophen; some doctors advise limiting anti-inflammatory drugs as they may slow bone healing, Protective footwear, a brace or a cast depending on the location
- Category
- Musculoskeletal · Common in runners, military recruits and athletes; accounts for a significant share of sports injuries
- See a doctor if
- Bone pain that persists during rest or at night
Symptoms
Causes
- A sudden increase in the intensity, duration or frequency of exercise
- Repetitive impact from running, jumping or marching, particularly on hard surfaces
- Weakened bone from osteoporosis, osteopenia or vitamin D deficiency
- Insufficient calorie intake relative to training, which impairs bone repair
- Hormonal disturbances, such as absent menstrual periods in female athletes
- Worn-out footwear or biomechanical problems such as flat feet or high arches
Risk Factors
- Participating in running, basketball, gymnastics, dance or military training
- Being female, especially with irregular or absent periods (the 'female athlete triad')
- Low bone density, low body weight or a history of eating disorders
- Previous stress fractures
- Low vitamin D or calcium intake
- Long-term use of corticosteroids or certain other medications
Diagnosis
- History of training changes and examination for a focal point of bone tenderness
- X-rays, which may appear normal in the first few weeks
- MRI, the most sensitive test for an early stress fracture
- Bone scan or CT in selected cases
- Blood tests for vitamin D, calcium and hormone levels if bone health is a concern
Treatment
- Rest from the activity that caused the fracture, usually for 6 to 8 weeks, with crutches or a walking boot for some sites
- Pain relief with ice and acetaminophen; some doctors advise limiting anti-inflammatory drugs as they may slow bone healing
- Protective footwear, a brace or a cast depending on the location
- Surgery with pins or screws for high-risk fractures, such as some in the hip, navicular or fifth metatarsal, that are prone to poor healing
- A gradual, supervised return to activity, often starting with low-impact exercise such as swimming or cycling
- Supportive: ensuring adequate calories, calcium, vitamin D and protein to support bone repair
- Supportive: addressing hormonal problems or low bone density with your doctor to prevent recurrence
Prevention
- Build up training gradually and alternate hard days with easy days
- Cross-train with low-impact activities to reduce repetitive load
- Eat enough to fuel your training, including calcium-rich foods and adequate vitamin D
- Replace running shoes regularly and use shoes suited to your foot type
- Address absent or irregular periods promptly with a doctor
- Do strength training to support bones and muscles
When to See a Doctor
- Bone pain that persists during rest or at night
- Pain in a specific spot on a bone that worsens with each workout
- Pain in the hip, groin or front of the shin, as fractures in these areas can be serious if missed
- Swelling or bruising over the painful area
- A history of stress fractures, missed periods or low bone density with new bone pain
Frequently Asked Questions
Related Conditions
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