A stress fracture is an overuse injury caused by repeated movements. Any bone in the body can have a stress fracture, but they are most common in the legs. Other names for stress fractures include "fatigue fracture" and "march fracture." "March fracture" comes from military recruits who have to take long marches while carrying heavy gear. It is common for athletes to have stress fractures of the tibia, one of the bones in the lower leg. Stress fractures are also common in the bones of the feet.
Usually a fractured bone results in the bone being broken into two or more pieces. The break is easily seen on an x-ray. A stress fracture is very tiny so it may not show up on an x-ray. If an x- ray is taken several weeks later, the healing process will have started and will show on an x-ray. The healthcare provider usually makes the diagnosis by the symptoms and takes an x-ray at a later time.
The symptoms include bone pain and tenderness. The pain or tenderness may start very slowly and gradually get worse. Occasionally, it may start suddenly. The pain usually stops with rest and gets worse with activity. It is usually a specific sport or activity that causes the pain. There may be some slight swelling.
A provider needs to be seen to evaluate this type of injury. Stress fractures have similar symptoms to shin splints and may be hard to diagnose.
Resting the part that is causing the pain is the most important part of the treatment. Cloth-covered ice packs can be put on the area for no more than 20 minutes 4 to 8 times a day. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can be taken to relieve the discomfort. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome. Non-steroidal anti-inflammatory drugs (NSAIDs) should be taken with food or milk to prevent stomach upset. NSAIDs should be avoided by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).
The provider can suggest how much exercise can be done during the healing process. A runner with a stress fracture may have to give up running for several weeks but can usually continue to walk. A sport that does not put weight on the leg such as swimming may be done instead of running. After 4 to 6 weeks or more of rest, the activity can be started again. Proper shoes and conditioning are required when restarting the sport.
Stress fractures can be avoided. They can be prevented by gradually making changes in training, including warming up and stretching before starting an exercise. The correct shoes for the sport should be worn. They should give good arch support and cushioning. Sometimes orthotics may be necessary. If the ankle tends to roll in, a change in running or walking style may be necessary. Running on hard surfaces should be avoided.
Last Reviewed 2005
Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.
HIL File BONE4248.RF2 VRS# 4248 Version 7.0 Copyright 2003 McKesson Health Solutions LLC. All rights reserved.