Overview

A stress fracture is a small crack or severe bruising within a bone, most commonly caused by repetitive force or overuse. These fractures often develop gradually over time and are commonly seen in athletes, runners, and individuals who engage in high-impact activities. While stress fractures can affect any bone, they most frequently occur in weight-bearing bones such as those in the lower leg and foot. Early identification and appropriate management are essential to prevent the injury from worsening and to promote proper healing.

Causes

Stress fractures are primarily caused by repetitive stress and overuse of a particular bone without adequate rest or recovery time. Common contributing factors include:

• Overuse: Repetitive high-impact activities such as running, jumping, or dancing without sufficient rest can lead to bone fatigue.
• Sudden increase in activity: Rapid escalation in intensity, duration, or frequency of exercise without proper conditioning can overload bones.
• Poor footwear: Wearing unsupportive or worn-out shoes can increase stress on the bones of the feet and legs.
• Improper technique: Poor athletic form or posture can unevenly distribute forces, leading to focal bone stress.
• Low bone density: Conditions like osteoporosis or nutritional deficiencies (especially calcium and vitamin D) increase fracture risk.
• Biomechanical abnormalities: Flat feet, high arches, or leg length discrepancies can contribute to abnormal stress on bones.

Symptoms

Stress fractures usually present with localized pain that develops gradually and worsens with activity. Key symptoms include:

• Localized pain: Persistent pain that intensifies during physical activity and improves with rest.
• Tenderness: A specific point of tenderness over the affected bone when touched.
• Swelling: Mild to moderate swelling around the site of the fracture.
• Bruising: In some cases, visible bruising may occur near the injury.
• Reduced performance: Decline in athletic performance or inability to continue activities due to pain.
• Worsening symptoms: Without rest, pain may become constant, even during normal daily activities.

Diagnosis

Diagnosing a stress fracture involves a detailed clinical evaluation and appropriate imaging studies:

• Physical examination: A healthcare provider will assess pain location, swelling, and perform targeted pressure tests.
• Medical history: Discussion about activity levels, recent changes in training, footwear, and medical conditions.
• X-rays: While initial X-rays may appear normal, they can detect healing signs after a few weeks.
• MRI scan: Magnetic resonance imaging is the most sensitive method to identify early stress fractures and soft tissue involvement.
• Bone scan: In some cases, a bone scan may be used to detect increased bone activity indicative of a stress fracture.

Treatment

Treatment of stress fractures focuses on rest, pain management, and gradual return to activity:

• Rest: The most important treatment is to avoid weight-bearing or high-impact activities that caused the injury, allowing the bone to heal.
• Activity modification: Engage in low-impact activities such as swimming or cycling during recovery.
• Immobilization: In certain cases, the use of a walking boot, brace, or crutches may be necessary to reduce stress on the bone.
• Ice therapy: Applying ice packs helps reduce pain and inflammation.
• Medications: Over-the-counter pain relievers like acetaminophen can help manage discomfort (NSAIDs are used cautiously as they may impair bone healing).
• Gradual return to activity: After adequate healing, a structured, gradual return to full activity is recommended under professional guidance.
• Treat underlying causes: Addressing risk factors such as improving footwear, correcting biomechanics, or treating low bone density is essential.

Prognosis

With proper treatment and adherence to rest, most stress fractures heal completely within 6 to 8 weeks. The prognosis is generally excellent if managed early and appropriately. Individuals who ignore symptoms or resume high-impact activities too soon are at risk for incomplete healing, chronic pain, or progression to a full fracture.

Preventive strategies, including gradual training increases, appropriate footwear, balanced nutrition, and addressing biomechanical abnormalities, can significantly reduce the risk of future stress fractures. Once healed, most people can return to their normal activity levels without long-term complications.