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Stress Fractures


What is a stress fracture?


A stress fracture is an overuse injury.  It occurs when muscles become fatigued and are unable to absorb added impact.  Eventually, the fatigued muscles transfer the additional stress to the bone. This repeated impact on the bone causes a tiny crack or break in the bone called a stress fracture. One of the most common injuries in sports is a stress fracture of the bone.


What causes a stress fracture?


Stress fractures are often the result of increasing the amount or intensity of an activity too rapidly.  They can also be caused by the impact of an unfamiliar surface; improper equipment; and increased physical stress.


What are some examples of athletes at risk of developing stress fractures?

-A tennis player who has switched from a soft clay court to a hard surface.

-A runner using worn shoes with an off balance sole.

-A basketball player who has had a substantial increase in playing time.


Are women more susceptible to stress fractures than men?


Medical studies have shown that female athletes seem to experience more stress fractures than their male counterparts.  Some researchers attribute this  to a condition referred to as “the female athlete triad. ”  This triad is made up of eating disorders (bulimia or anorexia), amenorrhea (infrequent menstrual cycle) and osteoporosis (weak bones).  As a female’s bone mass decreases, the chances of getting a stress fracture increase.


Where do stress fractures occur?


Most stress fractures occur in the weight bearing bones of the lower leg and foot.  More than 50% of all stress fractures occur in the lower leg.

What activities make athletes most susceptible to stress fractures?


Studies have shown that athletes participating in tennis, track and field, gymnastics,

and basketball are very susceptible to stress fractures.  In all of these sports, the repetitive stress of the foot striking the ground can cause trauma.  Without sufficient rest between workouts or competitions, an athlete risks developing stress fractures.


How are stress fractures treated?


The most important treatment is rest.  Individuals need to rest from the activity that caused the stress fracture and engage in a pain free activity during the six to eight weeks that it takes most stress fractures to heal. 


If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal fractures can result.  Re-injury also could lead to chronic problems where the stress fracture might never heal properly.


In rare situations, surgery is recommended to prevent and impending fracture or to treat a chronic injury.


Preventing Stress Fractures.


Here are some tips developed by the AAOS to help prevent stress fractures:


  • Slowly increase any new sports activity. For example, do not immediately start running five miles a day; instead, gradually build up your mileage on a weekly basis.  Running can also be done on alternate days.  Try alternating the days that you run on a weekly basis.

  • Maintain a healthy diet. Make sure you incorporate calcium-rich meals in your diet.

  • Use proper equipment.  Do not wear old or worn running shoes.

  • If pain or swelling occurs, immediately stop the activity and rest for a few days.  If continued pain persists, see an orthopaedic surgeon.


It is important to remember that if you recognize the symptoms early and treat them appropriately, you can return to sports at your normal playing level.

These images demonstrate a stress fracture of the 5th metatarsal in the foot. In certain situations, these fractures may need surgical fixation with a screw or graft material to heal properly.


1. Stress Fractures -OrthoInfo - AAOS. Accessed May 14, 2017.

2. Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures of the Foot and Ankle in Athletes. Sports Health. 2014;6(6):481. doi:10.1177/1941738113486588.

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