Stress Fracture

(Fracture, Stress)

Definition

A stress fracture is a tiny crack in the bone. They are most common in the lower leg and foot.

Stress Fractures of the Tibia and Fibula

Causes

This fracture is caused by repeated stress or overuse from:

Increasing the amount or intensity of an activity too quickly
Changing to a new playing surface
Not wearing the right shoes or wearing old shoes for a sport

Risk Factors

Stress fractures are more common in women. Things that may raise the risk of this fracture are:

A sudden increase in activity
Not getting enough rest between physical activities
Playing sports that involve running and jumping, such as track and field, tennis, gymnastics, and basketball
Having female athlete triad
Bone disorders, such as osteoporosis and Paget disease
Low levels of vitamin D and calcium
Smoking
Alcohol use disorder

Symptoms

Symptoms may be:

Pain that is worse with activity and better with rest
Swelling

Diagnosis

The doctor will ask about symptoms and past health. They will also ask about regular activities. A physical exam will be done. The doctor may suspect a stress fracture based on symptoms. Images may be taken if pain is severe or fracture is not healing as expected. Tests may be:

Treatment

It can take 6 to 8 weeks for a stress fracture to heal. The goals of treatment are to manage pain and support the bone as it heals. Options may be:

Walking boot, crutches or a cane to keep weight off of a foot or leg stress fracture.
Limiting activity that is causing pain or stress.
Medicine to ease pain and swelling.
Exercises to help with muscle strength and range of motion will be needed.

Prevention

To lower the chance of a stress fracture:

Slowly increase the amount and intensity of activities over time.
Wear the right shoes for sports.
Eat a diet that contains foods with vitamin D and calcium.

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 website. Available at: https://www.dynamed.com/condition/femoral-stress-fracture. Accessed September 30, 2020.

Stress fractures. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Accessed September 30, 2020.

Stress fractures of the foot and ankle. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/stress-fractures-of-the-foot-and-ankle. Accessed September 30, 2020.

Tibial plateau fracture. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/tibial-plateau-fracture. Accessed September 30, 2020.

Welck MJ, Hayes T, et al. Stress fractures of the foot and ankle. Injury 2017 Aug;48(8):1722.

Revision Information

Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Review Date: 01/2021
Update Date: 09/08/2020

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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.