Stress Fracture

What is Stress Fracture

Stress fracture is a small break or crack in a bone. A stress fracture can be fully broken (complete) or partially broken (incomplete).

The most common sites for stress fractures are the bones in the front of your feet (metatarsals), your heel (calcaneus), and the long bone of your lower leg (tibia).

A stress fracture is an overuse injury that occurs when periosteal resorption exceeds bone formation. History is generally consistent with a recent increase in the level of training followed by the insidious onset of pain.

The tibia is the most common site for stress fractures (30%) in runners, but other areas can be affected depending on the activity or sport. A tibial stress fracture causes pain in runners the entire time they are running as well as afterward. There is often a focal area of tenderness along the anterior tibia and percussion of the bone away from the site can cause pain at the fracture. The pain is increased if a vibrating 128-Hz tuning fork is placed on the site (75% sensitivity). Radiographs are usually negative at onset but become abnormal after ≥5 weeks. A bone scan shows uptake, and computerized tomography scan/MRI scans are abnormal and will sometimes show the “dreaded black line”. Avoidance of activity is necessary to permit repair and to prevent progression to complete fracture.

What are the causes?

Stress Fracture is caused by overuse or repetitive exercise, such as running. It happens when a bone cannot absorb any more shock because the muscles around it are weak. Stress fractures happen most commonly when:

• You rapidly increase or start a new physical activity.
• You use shoes that are worn out or do not fit properly.
• You exercise on a new surface.

What increases the risk?

You are more likely to develop Stress Fracture if:

• You have a condition that causes weak bones (osteoporosis).
• You are female. Stress fractures are more likely to occur in women.

What are the symptoms of Stress Fracture?

The most common symptom of a stress fracture is feeling pain when you are using or putting weight on the affected part of your body. The pain usually improves when you are resting. Other symptoms may include:

• Swelling of the affected area.
• Pain in the area when it is touched.

Stress fracture pain usually develops over time.

How is Stress Fracture diagnosed?

Stress Fracture may be diagnosed by:

• Your symptoms.
• Your medical history.
• A physical exam.
• Imaging tests, such as:
  • X-rays.
  • MRI.
  • Bone scan.

How is Stress Fracture treated?

Treatment depends on the severity of your stress fracture. It is commonly treated with resting, icing, compression, and elevation (RICE therapy). Treatment may also include:

• Medicines to reduce inflammation.
• A cast or a walking shoe.
• Crutches.
• Surgery. This is usually only in severe cases.

Follow these instructions at home:

If you have a cast:

• Do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean.
• If the cast is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

If you have a walking shoe:

• Wear the shoe as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the shoe if your toes tingle, become numb, or turn cold and blue.
• Keep the shoe clean.
• If the shoe is not waterproof:
  • Do not let it get wet.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area:
  • If you have a walking shoe, remove the shoe as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Activity

• Rest as directed by your health care provider. Ask your health care provider if you may do alternative exercises, such as swimming or biking, while you are healing.
• Return to your normal activities as directed by your health care provider. Ask your health care provider what activities are safe for you.
• Perform range-of-motion exercises only as directed by your health care provider.

General instructions

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches if your health care provider tells you to do so.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is Stress Fracture prevented?

• Only wear shoes that:
  • Fit well.
  • Are not worn out.
• Eat a healthy diet that contains vitamin D and calcium. This helps keep your bones strong. Good sources of calcium and vitamin D include:
  • Low-fat dairy products such as milk, yogurt, and cheese.
  • Certain fish, such as fresh or canned salmon, tuna, and sardines.
  • Products that have calcium and vitamin D added to them (fortified products), such as fortified cereals or juice.
• Be careful when you start a new physical activity. Give your body time to adjust.
• Avoid doing only one kind of activity. Do different exercises, such as swimming and running, so that no single part of your body gets overused.
• Do strength-training exercises.

Contact a health care provider if:

• Your pain gets worse.
• You have new symptoms.
• You have increased swelling.

Get help right away if:

• You lose feeling in the injured area.

Summary

• A stress fracture is a small break or crack in a bone. A stress fracture can be fully broken (complete) or partially broken (incomplete).
• This condition is caused by overuse or repetitive exercise, such as running.
• The most common symptom of a stress fracture is feeling pain when you are using or putting weight on the affected part of your body.
• Treatment depends on the severity of your stress fracture.