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Stress Fractures

Playing for the varsity basketball team was much tougher than Amy thought. The coach held long practices with lots of conditioning drills, and Amy would go home exhausted. Even worse, her right foot ached during and after every practice, though it seemed to get better when she rested afterward.

Amy's foot never seemed to heal completely, though. In fact, the pain got worse, beginning earlier each practice and lingering even after she rested. Finally, she went to see a doctor, who ordered an X-ray and told Amy she had a stress fracture in her foot.

What Is a Stress Fracture?

A stress fracture is a tiny crack in a bone that usually happens from overuse. Putting repetitive strain on bones can break them down. Resting gives bones a chance to rebuild, the way muscles do.


But when someone increases the amount of strain — as can happen when running farther or starting a new sport — sometimes the body can't keep up. The bones can't handle the added stress, and they start to develop tiny cracks called "microfractures." These can lead to stress fractures.

Stress fractures are one of the most common injuries in sports, especially for track and field athletes, gymnasts, dancers, tennis players, and basketball players. Stress fractures aren't just a problem for active people, though. They also affect people with weak bones or nutritional deficiencies, and can happen in the foot, leg, spine, arm, ribs, and other bony locations.

Doctors consider stress fractures "low risk" or "high risk" depending on where they are on the body. Someone with a fracture that is "high risk" has a greater chance of developing complications — like the fracture doesn't heal well or leads to more fractures. Low-risk stress fractures do not usually lead to complications.

Low-risk fractures usually happen in the upper parts of the body, like the ribs or arm bone, although some fractures in the foot can also be low risk. High-risk fractures are usually in the thigh bone (femur), kneecap, certain foot bones, and parts of the spine.

Symptoms of a Stress Fracture

It's not always easy to tell if you have a stress fracture. You can't see it, and any pain or discomfort can be barely noticeable when a stress fracture first starts. But stress fractures can get worse quickly.

Some of the things people with stress fractures might notice:

  • pain in the foot or leg, spine, and other locations when exercising that goes away when resting
  • pain that starts happening earlier in the activity each time it's done
  • pain that gets worse with time and can be felt even after rest
  • an area of the affected bone that is painful to touch
  • occasionally, mild swelling and redness

How Do Doctors Diagnose Stress Fractures?

If you often feel pain in the same part of your foot, leg, arm, or spine when you exercise, see a doctor. If your doctor thinks you have a stress fracture, he or she will ask questions about your activity level and other things that might put you at risk for stress fractures.

Your doctor also will examine the affected area, touching it to to check for tenderness and looking to see if there's any redness or swelling. The doc may order imaging tests, like an X-ray. But some stress fractures don't show up on an X-ray until a few weeks after the bone starts hurting, so your doctor may order an MRI (magnetic resonance imaging) scan or a bone scan. These types of tests are are better at ruling out a stress fracture because they can pick up smaller fractures before they get worse.

Causes of Stress Fractures

Stress fractures happen mostly in the lower limbs, like the foot or lower leg, where bones get more pressure from bearing weight.

But people also get stress fractures in the upper limbs if the sports they play put repetitive strain there. The swings and twists required in sports like tennis or golf can cause stress fractures to the arms or ribs. And the backbends involved in gymnastics can lead to stress fractures of the spine.

Some things that can lead to stress fractures in athletes include:

  • previous stress fractures
  • increasing the intensity or length of workouts, such as adding miles to a running regimen or practicing a sport more than you're used to
  • wearing worn-out shoes, shoes that don't fit well, or shoes that aren't designed for the activity
  • starting an intense training or exercise program after a period of inactivity

Girls are at greater risk of getting stress fractures than guys are. Also, a number of physical things raise a person's chances of developing a stress fracture, including:

  • a low level of physical fitness, which causes problems with muscle strength. Weak muscles put the bones at greater risk of fractures.
  • poor bone health that causes the bones to be weak or brittle. This can be related to not getting enough calcium and vitamin D in the diet.
  • not getting proper nutrition, as can happen in people with eating disorders
  • high, inflexible arches or flat feet, which may increase the risk of stress fractures of the tibia (the bigger bone in the lower part of the leg)

Can I Prevent a Stress Fracture?

Whatever your exercise routine, eating foods with plenty of calcium, vitamin D, and other nutrients help keep bones strong. And, keeping bones strong may decrease your risk of a stress fracture.

The best way to prevent a sports-related stress fracture is to be smart about the way you train and exercise. Here are some tips:

  • Start any new activity or exercise slowly and increase the duration and intensity of the activity gradually. Don't go out and try to run 10 miles the first time you go for a jog, or play basketball for 3 hours the first time you step on a court. Build up to that level of exercise over time. Your doctor, a sports medicine specialist, or an athletic trainer can give you advice on how to gradually increase your level of activity.
  • Pay attention to technique when you train or compete. To prevent injury, warm up before practices and meets, and use good technique and posture in all activities.
  • Work low-impact activities into your training regimen. This gives your legs and feet time to rest between workouts. For example, if you have gymnastics practice 5 days a week, give your legs a break on the weekend by going for a swim or a bike ride instead. This can also increase your muscle strength and overall heart fitness.
  • Don't wear old or worn-out shoes. Get the right shoes for your activity and be sure they give your feet plenty of support and cushioning. Using shock-absorbing inserts in your shoes can reduce stress fractures.
  • If you notice any pain or swelling, stop doing the activity. Give the affected part of your body — such as your foot or leg — plenty of time to rest. Ask your doctor how long this should be.

Treating Stress Fractures

If noticed early and treated correctly, most stress fractures will heal by themselves in a matter of weeks. But if someone resumes activities too soon, tiny stress fractures can become larger and harder to heal. Re-injuring a stress fracture can also lead to a painful, long-lasting condition where the fracture might never fully heal.

Treatment for a stress fracture includes:

  • Stop doing activities that put stress on your legs, feet, spine, or other injured area. Rest is the most important part of treatment for a stress fracture. Stay off your feet as much as possible until you've been cleared by a doctor to go back to your normal activities.
  • Use ice or a cold compress to reduce swelling. A typical regimen might involve icing the injury as needed every 3 hours for 15 minutes each time.
  • Ask your doctor about which pain medicines to take. Some doctors suggest using acetaminophen instead of ibuprofen, so it's a good idea to check first.

If you have a high-risk stress fracture, it's wise to be evaluated by an orthopedic doctor. You might need a brace or splint to protect the fractured area and to keep it free from movement, and possibly crutches.

In rare cases, some high-risk stress fractures may need surgery if other treatments don't work.

If there are other reasons for stress fractures, such as poor nutrition or eating disorders, people may need to seek nutritional or psychological counseling.

Check in With Your Body — and Take Action

It can be tempting to ignore stress fractures, especially at first when they don't hurt too much. But part of being a good athlete is keeping your body in top shape. The old-school idea of "playing through pain" just doesn't cut it anymore.

Make it a point to check in with your body after you exercise to be sure everything's OK. Do a mental scan of your body and notice whether you feel any unusual pain, especially in your legs or feet. You want to stay in top competitive shape!

Reviewed by: Rupal Christine Gupta, MD
Date reviewed: August 2014