Introduction

Stress fractures are tiny hairline breaks in the bone. They tend to develop in the legs or feet of dancers, athletes, or military personnel who exercise when their muscles are fatigued or when their bodies are not yet conditioned to the activity level. Rest and physical therapy can help most stress fractures heal. Surgery is used in select cases.

Anatomy

Your leg contains two bones. The larger bone, commonly called the shinbone, is the tibia. The thinner bone on the outer side of the leg is the fibula. The fibula is a common site of stress fractures.

Stress fractures also tend to occur in certain bones in the feet. Stress fractures commonly occur in the heel (calcaneus), the midfoot (navicular bone), and second and third metatarsals. The metatarsals are long bones in the forefoot that attach to the toes.

Causes

High impact, overuse, or improper form during sports or movements cause stress fractures. Stress fractures occur from repeated stress to the bones. Because of the repetitive stress, the bones are not able to repair themselves. In some cases, the bones may be already weakened by disease, such as osteoporosis, and be vulnerable to fracturing.

People that begin a strenuous exercise routine before they are conditioned or over train to the point of significant fatigue are at risk for stress fracture. Using improper form during exercise or sports or inadequate sports equipment and shoes can cause stress fractures. Dancers, military members in initial training, and athletes that participate in high impact sports are at risk for stress fractures because of jumping, running, and marching.

Females have a higher risk because of the effects of hormones on muscles and ligaments. Tall people, those with leg length discrepancies, and cigarette smokers also have a higher risk. Some people have an inherited predisposition for stress fractures.

Symptoms

Stress fractures cause gradual pain that becomes progressively worse with activity. Rest may relieve pain, although night pain is common. The top of your foot or outside of your ankle may become swollen, bruised, or tender.

Diagnosis

If you suspect that you have a stress fracture, you should try to keep weight off of your foot until you see the doctor. A doctor can diagnose a stress fracture by reviewing your medical history and examining you. You should tell your doctor about activities that may have contributed to your fracture.

An X-ray or bone scan will be used to create an image of your bones to confirm the fracture. Fractures typically do not show up on X-rays until later, so a bone scan, which is more sensitive, may be used. MRI scanning is an excellent method for diagnosing stress fractures not seen on plain x-rays.

Treatment

Rest is the primary treatment for most stress fractures. Your doctor may prescribe medications to relieve pain. Depending on the site and extent of the fracture, periods of rest and activity modification can range from 4 to 12 weeks. You may need to use crutches when you walk to keep weight off of your foot. Your doctor may recommend a rigid soled shoe or removable fracture brace. Some fractures may require casting.

At the appropriate time, you may be referred to physical therapy for rehabilitation. Physical therapists can teach you exercises to strengthen and balance your muscles, as well as overall general conditioning. Aquatic therapy is great for conditioning because the buoyancy of the water removes stress from the legs and feet.

Surgery

Surgery is used for select fractures that do not otherwise heal, or in areas that typically heal more slowly. Surgical hardware, such as screws or fixation devices, is placed internally to position the bones while they heal. Bone grafting may be used in some cases.

Recovery

Recovery times depend on the extent of your stress fracture and the treatment you receive. Surgical treatments can require up to several months of healing time. Non-surgical treatments typically have a shorter recovery period. Recovery is an individualized process, and your doctor will let you know what to expect. As your condition improves, your doctor will increase your activity level.

Prevention

You can help prevent stress fractures by wearing the appropriate athletic shoes for your activity. Make sure to not overdo training or exercise. Rest, especially when your muscles are tired. Condition your body for “spring training” before participating fully in any sport. Stop smoking, and eat a healthy well-balanced diet.