Stress Fractures

What is a stress fracture?

A stress fracture is a hairline crack that can occur in bones from repeated or prolonged use. The most common sites for stress fracture are the foot bones (metatarsals), shin bone (tibia), outer lower leg bone (fibula), thigh bone (femur), hip (neck of femur), and back bones (vertebrae).

What is the cause?

Stress fractures usually happen from overuse—for example, from running a lot of miles or jumping in basketball.

What are the symptoms?

Symptoms may include:

• pain
• swelling
• bruising

How is it diagnosed?

Your healthcare provider will ask about your symptoms and how the injury happened. Your provider will examine the leg and any other injured areas. You will have X-rays. X-rays don’t always show a stress fracture. You may have a more specialized test called a bone scan or an MRI.

How is it treated?

The treatment depends on the type of fracture. You may need to have a cast or wear a removable cast boot for several weeks. Sometimes surgery is needed.

How can I take care of myself?

Follow the full course of treatment your healthcare provider prescribes. The most important treatment for a stress fracture is rest. Also:

• To keep swelling down and help relieve pain, your healthcare provider may tell you to:
  • Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured area every 3 to 4 hours for up to 20 minutes at a time for the first day or two after the injury.
  • Keep the injured area up on pillows when you sit or lie down.
  • Take pain medicine, such as ibuprofen, as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• If you have a cast, make sure the cast does not get wet. Cover the cast with plastic when you bathe. Avoid scratching the skin around the cast or poking things down the cast. This could cause an infection.
• Use crutches or a cane as directed by your healthcare provider. Your provider will tell you how much weight you can put on your leg, if any.
• If you are a runner, run only if there is no pain.
• Change your activity—for example, you might need to start swimming instead of running.

Keep all appointments for provider visits or tests. Call your healthcare provider right away if:

• You have more pain, redness, warmth, or swelling.
• You have a fever.
• The injured area looks pale or blue or feel cold.
• You have a loss of feeling in the injured area.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your fracture heals, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

After a stress fracture you may do activities that do not cause pain. You should vary your activity for one week at a time. For instance, if you have a stress fracture from running, you should either rest or swim for a week, then attempt to run short distances. If there is no pain, you can gradually increase your activity level.

How can I prevent a stress fracture?

The best way to avoid stress fractures is to listen to your body and not force yourself to do activities while you are in pain.