15841 Stress Fractures

Overview

A stress fracture is a tiny crack in a bone. It happens from repeated force or overuse, not from a single blow. It often occurs in the feet and lower legs.

Stress fractures are fairly common, especially among runners, dancers, and people in military training.

They can affect anyone at any age, but you are more likely to get one if you have recently increased your activity level, wear worn-out shoes, or have weak bones.

Symptoms

Common symptoms

• Pain that starts gradually and gets worse with weight-bearing activity like walking, running, or jumping.
• Pain that eases with rest and returns when you exercise again.
• Swelling, tenderness, or a warm feeling over the bone.
• Pain at night in some cases, though this is less common.

Symptoms in children

• Children and teens can get stress fractures too, especially if they play sports or train very hard.
• They may complain of shin pain, ankle pain, or foot pain that gets worse with activity.
• They might limp or avoid sports and physical education.

Symptoms in older adults

• Older adults may have stress fractures from weaker bones (osteoporosis) even with normal daily activities.
• Pain may be less specific and could be mistaken for arthritis.
• It may take longer for the fracture to heal.

Causes

Main causes

• Suddenly increasing how often or how hard you exercise.
• Doing a lot of high-impact activities — running, jumping, dancing, or marching.
• Using poor technique or worn-out, unsupportive shoes.
• Training on hard surfaces.

Risk factors

• Not having enough rest days between intense workouts.
• Weak bones from low calcium or vitamin D, or from osteoporosis.
• Being female with irregular or missed periods (a risk for lower bone density).
• Previous stress fracture or injury.
• Poor foot posture or flat feet.

When to see a doctor

See a doctor urgently if:

• If you cannot put any weight on your leg or foot, you need same-day medical help.
• If you have a sudden increase in pain, or pain with a popping or snapping feeling.

Book a routine appointment if:

• If you have bone pain that lasts more than a week, get it checked.
• If you have pain that only happens during exercise and keeps coming back.

Diagnosis

A doctor or sports medicine clinician will ask about your symptoms, activity level, and recent training. They will examine the area and press on the bone to find the painful spot.

Tests that may be done

• X-ray (can show some stress fractures, though early ones may not appear)
• MRI or bone scan (if the diagnosis is not clear from an X-ray)

What to expect at your appointment

You may be asked to stop the activity that causes pain. The doctor will tell you when to start again, usually after the bone heals.

Treatment

The main treatment is rest from the activity that caused the injury. Most stress fractures heal with time and a gradual return to activity.

Self-care at home

• Rest the affected bone — stop running, jumping, or other high-impact activities until pain goes away.
• Ice the area for 10 to 20 minutes at a time, a few times a day.
• Elevate the leg when resting if there is swelling.
• Use a walking boot or crutches if a healthcare professional advises them.

Medical treatments

Your healthcare provider may recommend pain relief for the short term (tell them if you have any medical conditions). They may also suggest physical therapy to help you return to activity safely. Some stress fractures need a cast or special boot.

When is surgery considered?

Surgery is rarely needed. It may be considered if the stress fracture is in a high-risk area or if it does not heal after many weeks of rest.

Living with this condition

Give yourself time to heal. You can do pain-free activities like swimming or cycling. Slowly increase your activity over several weeks.

Lifestyle tips

• Wear shoes that fit well and provide good support.
• Take rest days during training.
• Eat balanced meals with enough calcium and vitamin D for strong bones.

Diet and exercise

Eat foods rich in calcium (dairy, leafy greens, fortified plant milks) and vitamin D (fatty fish, eggs, or fortified foods). Ask your doctor or a dietitian if you need supplements.

Mental health and emotional wellbeing

It can be frustrating to step back from exercise while you recover. This is normal. Talk to your doctor, coach, or a counsellor if you feel low. If you are having thoughts of harming yourself, please reach out to a crisis helpline in your area.

Prevention

Many stress fractures can be prevented by building up your training slowly, wearing good shoes, and taking rest days. Strong bones help too.

Complications

If left untreated

• The stress fracture can enlarge and become a complete bone break.
• Healing may take much longer.
• You may develop chronic pain that lasts after the fracture heals.

Long-term outlook

The outlook is generally good. With proper rest and a gradual return to activity, most people fully recover and can return to their usual sport or activities.

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