Stress fractures comprise 1% to 7% of athletic injuries. A stress fracture can cause pain and limit an athlete’s or athletic individual’s ability to play or exercise. In fact, questions about stress fractures of various bones are some of the most common questions I receive through this site. I decided it might be helpful to write a post – similar to one I wrote on partial meniscectomy – addressing some of the common themes from those questions.

What is the difference between a stress fracture and a normal fracture?

An acute fracture results from a traumatic force large enough to break the bone. On the other hand, a stress fracture results from repetitive stresses below the level needed to break the bone. These repetitive stresses cause microfractures within the bone. If the athlete continues to perform the same activity, these microfractures lead to increased bone resorption and inadequate bone formation. The forces can create a stress reaction before progressing to a stress fracture.

Also read:
Optimize bone density to prevent stress fractures
Watch out for disordered eating

Who gets stress fractures and why?

Stress fractures often occur in people who perform some sort of repetitive physical activity. Runners, military recruits and athletes in jumping sports like basketball and volleyball often suffer lower extremity stress fractures. Females are statistically more likely to suffer stress fractures as well.

Runner with leg pain from possible stress fracture

What symptoms indicate an athlete might have a stress fracture?

An athlete or active individual often notices pain developing in a specific location along a bone with repetitive impact or repetitive motion. She might describe increasing her training – increasing distance, duration of training, intensity, etc. – over a short period of time. This increased stress without enough time for the bone to recover causes pain that develops earlier within a training session and takes longer to resolve. Other factors might include a change in shoes or training surface, inadequate nutrition and abnormal menstrual cycles.

Also read:
Ask Dr. Geier – Stress Fractures
Ask Dr. Geier – Femoral Neck Stress Fractures

X-rays often don’t show a stress fracture, so why should I get them?

If a patient has had pain for less than two weeks, x-rays will likely be negative. Plain x-rays often appear normal within two weeks after a stress fracture develops. New bone formation as the fracture starts to heal and other changes start to appear weeks after pain starts.

What test can be more helpful for stress fractures?

Bone scans were the definitive test for stress fractures, as they showed increased uptake within 2 to 3 days of the injury. They have largely been replaced, as orthopaedic surgeons tend to order MRIs. CT scans can help demonstrate sclerosis as stress fractures heal, so many surgeons prefer CT scans to follow fracture healing.

Also read:
Ask Dr. Geier – Navicular Stress Fractures
Ask Dr. Geier – Tibial Stress Fracture

Which stress fractures are potentially serious?

I will describe potential serious foot and ankle stress fractures in an upcoming post. Generally lower extremity stress fractures can be categorized as high risk or low risk. High-risk stress fractures refer to those that present a significant risk for nonunion (not healing) due to poor blood supply or tension across that part of the bone. These “high risk” stress fractures include stress fractures of the femoral neck, the anterior aspect of the tibial shaft, navicular, base of the fifth metatarsal, medial malleolus, sesamoids and talus. “Low risk” stress fractures include the calcaneus and lateral malleolus.

Female athlete with stress fracture

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Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures of the Foot and Ankle in Athletes. Sports Health: A Multidisciplinary Approach. May 14, 2013