Definition A stress fracture is a small crack in a bone. 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, joggers often develop stress fractures in the foot or shins from the repeated stress of running. 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 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 or osteoporosis, 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. 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 doctor to make sure there is no stress fracture.
How is the injury recognised? A person with a stress fracture usually has pain that will not go away. It usually continues to get worse each time the activity is tried. This history, along with a physical examination, points to a diagnosis of stress fracture. X-rays of the painful bone are taken first, but they are often normal. Special imaging tests may be done in some cases. Imaging tests called 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 non-steroidal anti-inflammatory drugs (NSAIDs)
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 like grass, instead of cement.
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 carries a risk of bleeding infection, and allergic reaction to the anaesthesia. 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 doctor.
Author: John Riddle Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 19/10/2004 Contributors Potential conflict of interest information for reviewers available on request
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