Stress Fracture

What is a stress fracture?

A stress fracture is a small crack in a bone. These fractures are most often a result of overuse and can occur with an increase in activity. Stress fractures occur most commonly in the weight-bearing bones of the legs. When a bone is subjected to a new stress, such as a new exercise routine, it may not be prepared for the increased workload, and as a result may fracture under the new stresses being applied. 

What are the symptoms of a stress fracture? 

The symptoms of stress fractures can vary widely. The most common complaint is pain. The pain may develop gradually and often is relieved by rest. Pain usually becomes more intense with physical activity and can be associated with swelling. It is rare to see bruising or discoloration. 

What causes a stress fracture?

​Overuse is the most common cause of a stress fracture. An increase in exercise, athletics, job duties, or even shoewear can bring on a stress fracture.

Other risk factors include repetitive and high-impact activities, such as running, gymnastics, and dance.

Osteoporosis may also increase the risk of a stress fracture. Weaker bones may be more susceptible to changes in activity. Any bone of the foot can develop a stress fracture. 

How is a stress fracture diagnosed?

​After listening to your medical history, your foot and ankle orthopaedic surgeon will examine your foot for areas of tenderness. A stress fracture is typically painful directly over the affected bone. X-rays are usually obtained. If the X-rays are normal but there is still a high suspicion for a stress fracture based on history and exam, additional imaging such as CT scan, bone scan, or MRI may be ordered.   

What are treatment options?  

​Since stress fractures most often occur as a result of overuse, the first treatment includes stopping the activity that brought on the fracture. A period of rest is typically needed. Low-impact type of exercise such as biking may be permitted if it does not cause pain.

If pain continues after rest from activity, additional treatment may be recommended. This can include shoewear modifications such as a stiff-soled shoe, a rigid insert or orthotic, or a walking boot. In certain cases, your doctor may recommend limited weightbearing with crutches, or even a cast. Calcium and vitamin D​ supplements may be prescribed to aid bone health.

Most stress fractures will heal with conservative tratment. If the bone fails to heal, surgery may be necessary. Surgery often involves placing metal plates and screws to secure the bone.  

Potential Complications 

The most common complication that occurs with a stress fracture involves the bone not healing, called a nonunion. Other complications include malunion, where the bone heals but in a abnormal position, or recurrent fractures. Recurrent fractures occur more often if the patient has osteoporosis. Patients with osteoporosis should speak with their doctor regarding treatment options.

Frequently Asked Questions 

How can I prevent stress fractures?

Start out slowly when beginning an exercise program. You should walk and stretch to warm up gradually before progressing to running. Make sure your shoes fit properly and have adequate cushioning. Take the time to cool down properly after exercise. If you begin to notice discomfort, avoid higher impact exercise and activity.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.