Stress Fracture

(Fracture, Stress)

Definition

A stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.

Stress Fractures of the Tibia and Fibula

Causes

A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:

Increasing the amount or intensity of an activity too quickly (most common)
Switching to a different playing or running surface
Wearing improper or old shoes

Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

Risk Factors

Stress fractures are more common in women. Other factors that may increase the chance of a stress fracture include:

Sports that involve running and jumping, such as:
- Tennis
- Track, especially distance running
- Gymnastics
- Dance
- Basketball
Absence or early stopping of menstrual cycle— amenorrhea
Reduced bone thickness or density— osteoporosis
Poor muscle strength or flexibility
Overweight or underweight
Poor physical condition

Symptoms

A stress fracture may cause:

Localized pain on the bone
Pain when pressure is applied directly over the fracture and the area around it
Pain when putting stress on the affected leg
Swelling and warmth at injury site

Diagnosis

You will be asked about your symptoms and medical history. The injured area will be examined for localized pain and swelling.

Imaging tests to evaluate your bones include:

X-rays —stress fractures are tiny and usually not seen on an x-ray until at least 2 weeks after symptoms begin
MRI scan
Bone scan

Treatment

Treatment includes:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.

Rest

Rest is important for a stress fracture. Activities will need to be adjusted during recovery. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks.

Shoe Inserts or Braces

Shock absorbing shoe inserts and pneumatic braces may provide comfort and quicken recovery.

Crutches or a Cane

Crutches or a walking cane may be needed to keep pressure off the leg.

Prevention

To help reduce your chance of a stress fracture:

Gradually increase the amount and intensity of an activity
Run on a softer surface, such as grass, dirt, or certain outdoor tracks
Do not overdo any activity
Wear proper footwear
Maintain a proper weight
Avoid smoking
Eat a healthy diet rich in calcium and vitamin D.

RESOURCES

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

Ortho Info—American Academy of Orthopaedic Surgeons
http://www.orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org

Canadian Orthopaedic Foundation
http://www.canorth.org

References

Femoral stress fracture. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115016/Femoral-stress-fracture . Updated March 20, 2017. Accessed September 1, 2017.

Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med. 2001;11:73-76.

Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011;83(1):39-46.

Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68(8):1527-1532.

Stress fractures. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 1, 2017.

Stress fractures of the foot and ankle. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116052/Stress-fractures-of-the-foot-and-ankle . Updated March 20, 2017. Accessed September 1, 2017.

Tibial plateau fracture. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116325/Tibial-plateau-fracture . Updated December 22, 2015. Accessed September 1, 2017.

Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: A review of the literature. PM R. 2010;2:945-949.

Rome K, Handoll HHG, Ashford RL. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database of Systematic Reviews. 2005;2:CD000450.

Wells CL. Women, Sport & Performance: A Physiological Perspective. Champaign, IL: Human Kinetics; 1991.

Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39:65-69.

Revision Information

Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Review Date: 09/2018
Update Date: 09/30/2013

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.