DefinitionA stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.
|Stress Fractures of the Tibia and Fibula|
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CausesA blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:
- Increasing the amount or intensity of an activity too quickly (most common)
- Switching to a different playing or running surface
- Wearing improper or old shoes
Risk FactorsStress fractures are more common in women. Other factors that may increase your chance of a stress fracture include:
- Sports that involve running and jumping, such as:
- Track, especially distance running
- Absense or early stopping of menstrual cycle—amenorrhea
- Reduced bone thickness or density—osteoporosis
- Poor muscle strength or flexibility
- Overweight or underweight
- Poor physical condition
SymptomsA stress fracture may cause:
- Localized pain on the bone
- Pain when pressure is applied directly over the fracture and the area around it
- Pain when putting stress on the affected leg
- Swelling and warmth at injury site
DiagnosisThe doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling.Imaging tests to evaluate your bones include:
- X-rays—stress fractures are very tiny and usually not seen on an x-ray until at least 2 weeks after symptoms begin
- MRI scan
- Bone scan
MedicationsNonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.
RestRest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks.
Crutches or a CaneYou may need crutches or a walking cane to keep pressure off the leg.
ActivityTalk with your doctor about when you can restart activity and how to progress with the amount and type of activity.A common progression:
- Begin with nonweight–bearing activities, such as swimming or bicycling.
- Next, you can do weight-bearing, nonimpact exercise, such as a stair machine.
- Gradually, you will be able to add low-impact activity, starting with walking.
- Once you can do fast-paced walking with no pain, you can start higher impact activity, such as light jogging.
- This gradual progression continues until you have reached your pre-injury activity level. You can return to full activity once you do not feel tenderness of the bone.
PreventionTo help reduce your chance of a stress fracture:
- Gradually increase the amount and intensity of an activity
- Run on a softer surface, such as grass, dirt, or certain outdoor tracks
- Do not overdo any activity
- Wear proper footwear
- Maintain a proper weight
- Avoid smoking
American Orthopaedic Society for Sports Medicine
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Femoral stress fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2012. Accessed September 29, 2014.
March fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed September 29, 2014.
Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med. 2001;11:73-76.
Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68(8):1527-1532.
Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 29, 2014.
Wells CL. Women, Sport & Performance: A Physiological Perspective. Champaign, IL: Human Kinetics; 1991.
Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39:65-69.
- Reviewer: Michael Woods, MD
- Review Date: 09/2013
- Update Date: 09/30/2013
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