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A stress fracture is a small crack in a bone that is not due to a single episode of trauma. Stress fractures usually occur in the foot, shin, outer leg, thigh, and back. A stress fracture usually happens when a bone is put through repeated or unusual stress.

For example, individuals who start running and have not been accustomed to it, or who rapidly increase the distance they run, often develop stress fractures in the foot or shins from the repeated stress. These fractures are usually small, but they can produce severe pain.

What are the signs and symptoms of the injury?

Pain is felt with any activity that affects the area of the stress fracture. For example, runners will start to feel pain every time they run. The pain often stops when activity is stopped, then comes back again when activity is started again. The area of the fracture is often tender to the touch.

What are the causes and risks of the injury?

Stress fractures are the result of overuse of the bone. Most stress fractures in younger adults are in the feet or legs. They are often caused by activities such as running, dancing, or jumping.

Older people, by contrast, are more likely to have stress fractures in other areas, such as the hips and back. Other risk factors include obesity and calcium deficiency. A history of bone or joint disease, such as arthritis, osteoporosis, osteopetrosis, or osteomalacia can increase the risk of stress fractures.

What can be done to prevent the injury?

Since stress fractures are usually caused by overuse, regular overexertion should be avoided. Individuals should increase their activity gradually. Sports safety guidelines should be followed for children, adolescents, and adults. If pain occurs, the activity should be discontinued. For example, a person should stop running if his or her feet seem to hurt during or after running. The person should see a healthcare professional to determine if there is a stress fracture.

How is the injury recognized?

A person with a stress fracture usually has pain that will not go away and usually gets worse each time the activity is tried. This history, along with a physical exam, points to a diagnosis of stress fracture. X-rays of the painful bone are taken first, but they are often normal. Special imaging tests such as MRIs and bone scans are commonly used.

What are the treatments for the injury?

A person who has a stress fracture needs to rest the affected area until the bone heals. This can take up to three months in some cases.

Other common treatments for stress fractures include:

• ice packs, applied for several days or until the pain disappears
• anti-inflammatory medications, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Because of the risk of Reye syndrome, aspirin should not be given to persons under 18 except under the guidance of a healthcare professional.
• avoiding activity that puts stress on the affected areas. An exercise that is not weight-bearing, like swimming, can be substituted for jogging.
• using special shoes or shoe inserts after the fracture heals. A person may also want to alter activity to reduce injury. For example, it can be helpful to jog on a softer surface such as grass instead of concrete or asphalt.

In rare cases, a splint or cast may be needed temporarily. Surgery may be needed for fractures that do not heal, or heal the wrong way.

What are the side effects of the treatments?

Aspirin or NSAIDs can cause allergic reactions, stomach upset, or kidney damage. Surgery can be complicated by bleeding, infection, or a reaction to the anesthetic. A cast or splint may irritate the skin.

What happens after treatment for the injury?

Stress fractures usually heal with proper treatment, but can sometimes recur. Any new or worsening symptoms should be reported to the healthcare professional.