Stress fractures are tiny cracks that develop in the weight-bearing bones.
Stress fractures are tiny cracks that develop in the weight-bearing bones.

Stress fractures are tiny cracks that develop in the weight-bearing bones. These are often caused by repetitive force to the bone such as during long marches, by repeatedly jumping up and down, or by running long distances. Because the cracks are tiny, you may be able to walk despite them, albeit painfully. However, doctors do not recommend this.

Stressing the fracture site repeatedly may cause the cracks to widen and the bone to weaken further. Doctors do not recommend walking when you have a stress fracture because it may reopen the partially healed fracture, and you may have to begin the recovery process again. Although you can walk, doctors would recommend staying away from hard surfaces and not walking long distances. Stress fractures are overuse injuries that occur in the weight-bearing bones of the lower body. They may develop when you subject your bones to repeated stress and force such as running, walking, or jumping and landing. The bones most likely to sustain stress fractures are as follows:

  • Fibula: The outer lower leg bone
  • Tibia: Shinbone (the inner lower leg bone)
  • Second and third metatarsals: The bones of the foot, just behind the toes
  • Calcaneus: The heel bone
  • Navicular: A midfoot bone close to where the top of the foot meets the ankle
  • Talus: One of the bones in the ankle joint

Much less common, but still possible, bones that can undergo stress fractures are as follows:

  • Femur: The thigh bone
  • Pelvis
  • Sacrum: The base of the spine

Although not as common, stress fractures can occur in the upper body (for example, in the ribs, wrists, or arm bones). If you are an athlete who uses your arms, shoulders, or trunk forcefully or if you have a loss of bone density from age or osteoporosis, you may experience a stress fracture above the waist.

How do I know if I have a stress fracture?

Normally, the body can sufficiently heal these microfractures, leading to a stronger bone that will accommodate these higher forces in the future. However, when forces on the foot are such that the body’s healing response cannot keep up, a stress reaction can develop. Eventually, if the forces continue, the bone structure can fail, and a stress fracture will occur. An individual’s lack of sufficient biology (low calcium, vitamin D, or thyroid hormone) to heal microfractures can also contribute or lead to stress fractures. If you have any of the following symptoms, you may have a stress fracture:

  • Pain that you feel most when you’re active; this pain gets more intense over the course of activity but improves with rest. Some people describe the pain of a stress fracture as deep soreness that gradually becomes debilitating or excruciating as you continue to move. The pain builds over time, eventually making the activity difficult if not impossible. When you rest, the pain subsides, but it will likely return when you resume activity.
  • Swelling around the site of the injury
  • Tenderness
  • Bruising

The only real way to confirm a stress fracture is to see a doctor for imaging.

  • X-raysMost foot and ankle fractures can be seen clearly on an X-ray. Several different angles of bone images may be necessary to successfully diagnose the condition. However, stress fractures may not show up on X-rays until they begin to heal, which is why additional scans or imaging tests may be necessary.
  • Bone scan: This scan helps identify breaks, fractures, and stress fractures by imaging a small amount of material that is injected into the imaging area. Damaged areas show up as bright spots on the image.
  • Computed tomography (CT) scans: These are used because oftentimes they may reveal more details about the bone and soft tissue around it than an X-ray image. CT scans combine multiple X-ray images to provide cross-sectional images of your foot and bones.

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What is the medical treatment for stress fractures?

Rest is the key to the initial treatment of a stress fracture. 

  • You may need a walking boot or brace along with a cast or crutches to help rest the injured area and limit the amount of weight bearing allowed. 
  • Anti-inflammatory medications such as ibuprofen are useful to help with inflammation and pain. Narcotic pain medications (codeine, hydrocodone, and oxycodone) may be considered initially to help with pain control.
  • Doctors may prescribe you calcium and vitamin D supplements to supplement your bone health.
  • Avoiding any activities that caused the injury or exacerbate the symptoms may help heal the stress fracture.
  • Doctors recommend correcting any risk factor that may predispose to further stress fractures, including training issues, footwear, and nutritional or hormonal deficiencies.
  • Certain stress fractures may require surgery to aid in healing or prevent nonhealing (non-union) or refracture. Internal fixation is the surgical method used for more severe stress fractures. During this procedure, pins, screws, and/or plates are used to hold the bones together.
  • During the healing process, doctors may recommend physical therapy to stretch muscle and restore range of motion and proper exercise to rebuild mobility and strength.

Stress fractures typically take 6-8 weeks to heal, and doctors normally recommend switching to non-weight-bearing activities during that period.

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Medically Reviewed on 3/5/2021
References
Stress Fractures: Diagnosis, Treatment, and Prevention: https://www.aafp.org/afp/2011/0101/p39.html