Stress Fractures

A stress fracture is a very small, fine crack in the bone caused by repeated overuse. While stress fractures can occur in many bones that are subjected to repetitive activities, the bones in the feet and legs are at greatest risk.

As a result, stress fractures often occur in athletes who play sports that involve a lot of running and jumping, such as basketball, soccer, gymnastics, and track and field.

Stress fractures are among the most common sports injuries. The most frequent sites of stress fractures include:

  • Tibia (shin bone)
  • Metatarsals (bones in the midfoot)
  • Fibula (the outer bone between the knee and the ankle)
  • Navicular (bone on top of the midfoot)
  • Heel
  • Talus (small bone in the ankle joint)

Less-common locations of stress fractures include the femur (thigh bone), pelvis and sacrum (a triangular bone in the lower back).

Stress fractures often occur when an athlete increases the type or intensity of an activity too quickly, or changes their workout surface (going from running on a treadmill to running on pavement outdoors, for example).

Also, if bones are weakened from a condition such as osteoporosis, even performing everyday activities may result in a stress fracture.

The most common symptom of a stress fracture is pain.

Left untreated, stress fractures often increase in severity until the pain becomes disabling. Over time, a bone with an untreated stress fracture may break completely, requiring more extensive treatment. That’s why it’s important to see a specialist for an accurate diagnosis and appropriate treatment as soon as symptoms appear.

Why Choose Cooper to Diagnose and Treat Stress Fractures

Cooper University Health Care has a team of seven board-certified and fellowship-trained sports medicine specialists with extensive experience in diagnosing and treating stress fractures. You can count on us for:

  • Fast access: Our policy is to see patients within 24 to 48 hours of a sports injury, whenever possible
  • Comprehensive diagnostic resources: Your doctor will take a thorough health history, perform a physical exam, and order appropriate tests, which will likely include:
    • Diagnostic imaging: X-rays often cannot detect a stress fracture soon after your pain begins because the crack is so fine, so a bone scan or MRI may be performed. An MRI usually can visualize stress fractures within the first week of injury. This test also can better distinguish between stress fractures and soft-tissue injuries.
  • Personalized treatment: Treatment is based on your age, general health and severity of symptoms, and aimed at relieving pain and giving the stress fracture time to heal (usually 6 to 8 weeks). Treatment may include:
    • Resting the affected area
    • Reduced weight bearing to protect the fracture site (you may need to wear a walking boot, brace or cast, or use crutches)
    • Icing the area to reduce inflammation and pain
    • Non-steroidal anti-inflammatory medications to reduce inflammation and pain
    • Injections of platelet-rick plasma (PRP) to speed healing time
    • Surgery (rare, but sometimes necessary to ensure complete healing of some stress fractures that occur in areas with poor blood supply)

Causes and Risk Factors of Stress Fractures

Stress fractures often occur when people increase the amount or intensity of an activity too quickly. In other words, they do too much, too soon.

Our bones adapt gradually to increased loads through what’s called remodeling. During remodeling, bone tissue is broken down then rebuilt. This process speeds up as the load on the bone increases.

But if you subject your bones to too much force, too quickly—without giving them enough time to recover and rebuild—it makes your bones more susceptible to stress fractures.

Some factors that can increase your risk of stress fractures include:

  • Participating in certain sports: Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, dance or gymnastics
  • Increasing activity too quickly: Suddenly going from a sedentary lifestyle to intense activity, or quickly increasing the intensity, duration or frequency of training/playing, puts you at increased risk
  • Gender: Women, especially those with irregular or no menstrual periods, are at higher risk of stress fractures
  • Weakened bones: People with osteoporosis, eating disorders which restrict necessary nutrients, or who have low vitamin D levels are more likely to develop stress fractures
  • Foot issues: People with flat feet or high arches are at greater risk of developing stress fractures
  • Previous stress fractures: If you’ve already had a stress fracture, it puts you at higher risk of having another one

Symptoms of Stress Fractures

The most common symptom of a stress fracture is pain. This pain often starts gradually and gets worse during weight-bearing activity. Other symptoms, which can occur differently in each person, may include:

  • Pain that goes away when you rest
  • Pain that intensifies during your normal everyday activities
  • Swelling at the site of the fracture
  • Tenderness to touch at the site of the fracture
  • Bruising

Preventing Stress Fractures

There are many steps you can take to prevent a stress fracture from occurring in the future—or in the first place. They include:

  • Use the right equipment: Worn running shoes lose their ability to absorb shock and can contribute to injury
  • Ease into a new activity: Gradually increase the time, speed and intensity of any new activity
  • Consume a healthy diet: A balanced diet with adequate amounts of vitamin D and calcium helps build and maintain bone strength
  • Mix things up: Vary your activities to avoid overworking one area of your body; alternate high-impact sports like running with low-impact activities like swimming.
  • Include strength training: Strength training—such as using free weights or resistance bands—helps prevent your muscles from getting fatigued too soon and slow the loss of bone density that comes with aging
  • Know when to stop and rest: If pain or swelling return, rest for a few days. If the pain doesn’t go away, see your doctor.

Make an Appointment With a Cooper Fracture Specialist

To learn more about the sports medicine services available for treating stress fractures at Cooper or to request an appointment, please call 800.8.COOPER (800.826.6737).