Stress fractures are small cracks in one or more bones that occur when sudden increases in physical activity or poor bone health increase significantly. They tend to affect the feet and lower legs most frequently. Stress fractures tend to develop more regularly when suddenly increasing physical activity levels or among individuals with poor bone health.
Your healthcare provider will perform a physical exam and may order x-rays. Any exercise that causes pain and tenderness in the area should be stopped until healing occurs.
What is a stress fracture?
Stress fractures are tiny cracks caused by repetitive force or overuse that result in repetitive minor injuries to weight-bearing bones in your feet and legs, most often those supporting weight like metatarsal bones (small bones in the balls of your feet), the calcaneus (heel bone), fibula (outer lower leg/ankle bone) or sesamoids (bones that support big toe). Stress fractures occur most commonly among weight-bearing bones like metatarsals (small bones in balls of your feet), calcaneus (heel bone), fibula (outer lower leg/ankle bone), and navicular bone (small bones in the arch of the foot) as well as sesamoids (the small bone that supports big toe). Bones continually break down and replace themselves. However, increased activity leads to faster breakdown than replacement by body processes, leading to tiny cracks forming.
Stress fracture sufferers typically experience pain that increases with activity and is relieved with rest, usually felt when walking, running, or jumping, and may include tenderness to touch the affected bone. They must seek a proper diagnosis as continuing exercise could worsen their injury, further preventing total healing of their wound.
Your doctor will perform a physical exam to ascertain where and how the pain is located and how it impacts movement, take x-rays to detect stress fractures or order an MRI or CT scan to obtain detailed images of bone.
Treatment for a stress fracture entails refraining from all weight-bearing activities and sports until all pain subsides. Your doctor may suggest wearing a walking cast or brace to keep weight off the injured bone, applying ice at two-hour intervals for 20 minutes each time, and prescribing medications to manage pain and swelling.
To avoid stress fractures, gradually begin any new exercise regime and increase intensity over time. Stretching and warming up before engaging in physical activities or sports. Furthermore, supportive shoes such as flat feet and high arches must be worn – they affect how your foot absorbs impacts when walking or running, which increases the risk for stress fractures.
What are the symptoms of a stress fracture?
Stress fracture pain tends to be localized and worsens when exercising or exerting yourself, with relief after rest or sleep or when recovering from physical activities like sports. Swelling may also occur as part of this overuse injury, often involving feet and lower legs taking on increased pressure during walking, running, or jumping activities. Most stress fractures occur on these parts of the body where movement occurs, such as walking, running, or jumping – these areas take on the most strain when moving your feet and legs around.
Stress fractures typically start as inflammation on a bone’s surface (known by healthcare providers as a “stress reaction”). If pressure continues to be applied to them before they have time to heal correctly, that reaction could develop into an indented bruise on one or more bones, eventually turning into a stress fracture.
Your doctor will likely order an X-ray as the initial step in diagnosing a stress fracture, as they can reveal minor fractures that might not appear on other imaging tests such as CT or MRI scans.
Your doctor will also request information about your symptoms and medical history, mainly if conditions affect how your foot absorbs impact, such as flat feet, high arches, or previous stress fractures. They will examine both feet and ankles thoroughly, pressing gently on injured areas until pain arises – this indicates a stress fracture is likely present.
After suffering a stress fracture, your doctor will advise that you refrain from high-impact activities for 6-8 weeks or until pain and swelling have subsided. Crutches or cane may help take pressure off injured bones; otherwise, they will advise protecting against injuries by gradually introducing your feet onto the ground while wearing appropriate footwear that provides sufficient shock absorption.
If your injury heals quickly, you should gradually return to regular activity, but beware that an earlier return could result in more significant problems that require more time to treat. A minor stress fracture could quickly become something meaningful that takes much more effort to manage.
How do I know if I have a stress fracture?
If your foot or ankle pain increases with impact activity, it could be a stress fracture. While athletes more commonly experience stress fractures than the general population, anyone suddenly increasing their activity’s frequency, duration, or intensity could potentially share this injury.
Stress fractures are typically treated by ceasing all activity that stresses the affected area, generally high-impact activities, for weeks or months. While this may be difficult, resting the place allows time for healing while preventing severe issues like complete fractures from developing.
Your doctor can diagnose a stress fracture by performing a physical exam and ordering X-rays of the area. While these may initially appear normal, sometimes broken bones heal by creating new bone growth that shows up as visible changes on an X-ray (known as calcification). An orthopedist or radiologist then confirms this diagnosis by touching the area to see how tender it feels.
Stress fractures often produce pain that increases with activity and resolves with rest, with sharp or shooting pain often worse in standing than lying down. If this pain doesn’t impede your everyday activities, your doctor might suggest pain-relief medication to control pain and swelling while your bones heal.
Most stress fractures heal independently without needing surgery, but your physician may recommend it if your injury has persisted for an extended period or is in an area with poor blood supply. In severe cases, surgery might also support fractured bones with pins, screws, or metal plates implanted to support and protect against future breakages.
Help avoid stress fractures by following a healthy diet rich in calcium and vitamin D, using proper sports equipment like shoes with cushioned insoles and arch supports, gradually increasing exercise volume over time, warming up before practices and meets, and increasing duration or intensity slowly to avoid unexpected injuries.
How do I treat a stress fracture?
Every repetitive action that puts stress on your bones can result in a stress fracture — most commonly in your lower leg (tibia and fibula) or foot (metatarsals connecting ankle, heel, and toes), though stress fractures aren’t solely limited to athletes and physical workers. As soon as pain, swelling, or tenderness arise in weight-bearing bones, you must see a healthcare provider as quickly as possible, especially if the pain increases during activity but doesn’t disappear when stopped – be proactive about seeking medical help!
Your healthcare provider will review your past health and physical activities, examine the area of injury, take X-rays to confirm diagnosis, look for bone growth abnormalities, and check blood tests to check for nutritional deficiencies such as low calcium or vitamin D levels.
Stress fractures typically start as minor bruises on the surface of bones (known in healthcare circles as “stress reactions”). Over time, repeated stress or pressure may push against that spot until, eventually, it cracks or breaks. Common causes for stress fractures include:
Increased levels or intensity of exercise too rapidly (this may include adding new activities, increasing workout frequency, or changing types). Failing to warm up or cool down before exercise. Exercising without adequate support for feet.
Before exercising on an injured bone, please consult a healthcare provider and try non-weight-bearing exercises that don’t put pressure on it. Your provider may suggest a shoe or splint to support and reduce stress on injured areas and recommend icing to decrease swelling and relieve pain.
Stress fractures typically heal with rest; however, if they’re not responding adequately, your doctor may suggest surgery to ensure proper area healing.
