A stress fracture is a small crack or microfracture in a bone, most commonly in the shin or foot, that causes symptoms such as pain, swelling, or tenderness in the affected area.
This type of fracture, also called a fatigue fracture, occurs when a bone is repeatedly overloaded, leading to bone fatigue. It is more common in competitive athletes, runners, military personnel, and dancers.
Treatment for a stress fracture is managed by an orthopedic surgeon and usually involves rest, immobilization of the affected area, medications to relieve symptoms, and, in some cases, surgery.
Common symptoms
The main symptoms of a stress fracture include:
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Gradual onset of pain in the affected area;
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Swelling around the painful area;
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Worsening pain after physical activity;
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Relief of pain with rest;
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Pain the morning after a workout;
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Increased tenderness to the touch.
Stress fractures most often occur in the tibia or fibula (shin bones), the metatarsals (bones of the foot), the calcaneus (heel bone), or the femoral neck (hip area).
In rare cases, a stress fracture can occur in the lumbar spine, often related to conditions such as spondylolysis or spondylolisthesis, which may cause lower back pain or sometimes no symptoms at all.
It is important to see an orthopedic surgeon if you develop symptoms of a stress fracture so that the cause can be properly diagnosed and treated.
Confirming a diagnosis
A stress fracture is diagnosed by an orthopedic surgeon through an evaluation of symptoms, medical and exercise history, and a physical exam.
To confirm the diagnosis, the doctor may order an X-ray, but the fracture may not always appear in the early stages and can take 2 to 3 weeks to become visible.
For a more accurate assessment, the doctor may recommend imaging tests such as:
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Magnetic resonance imaging (MRI);
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Computed tomography (CT) scan;
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Bone scintigraphy (bone scan).
Possible causes
A stress fracture develops due to bone fatigue from repetitive high-impact exercise, which increases bone resorption and decreases the formation of new bone tissue.
The most common causes include:
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High-impact sports such as running, volleyball, basketball, soccer, track and field, dance, or gymnastics;
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Muscle fatigue that reduces the ability to absorb impact during training;
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Sudden increases in workout intensity, duration, or frequency;
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Transitioning from treadmill running to outdoor running;
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Wearing inappropriate or worn-out shoes that fail to absorb shock;
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Osteoporosis;
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Calcium or vitamin D deficiency.
Poor nutrition, muscle loss, or hormonal imbalances, especially low estrogen or testosterone levels in athletes, can also increase the risk of stress fractures.
Stress fractures are also common in people who previously had a sedentary lifestyle and start exercising without medical or professional guidance.
Treatment options
Treatment for a stress fracture should always be managed by an orthopedic surgeon to promote bone healing and relieve symptoms.
1. Rest
Rest helps reduce pain and discomfort and allows the bone to heal. Training and high-impact activities should be stopped temporarily.
The amount of rest needed depends on the severity of the fracture and should be determined by the orthopedic surgeon.
2. Cold compresses
Applying a cold compress to the affected area can help reduce pain and swelling.
To make a cold compress, place ice cubes in a thermal bag or use a gel pack chilled in the freezer. Wrap it in a clean, dry towel and apply to the affected area for 15 to 20 minutes, two to three times a day.
3. Immobilization
Immobilization helps reduce pressure on the bone, maintain proper alignment, and support healing.
This can be done using a walking boot or crutches for 2 to 6 weeks, depending on the location and severity of the fracture.
4. Medications
Medications used to treat a stress fracture may include anti-inflammatories or pain relievers such as ibuprofen or acetaminophen to help reduce pain and swelling.
These medications should only be used under medical supervision and for a short period of time, as directed by the doctor.
If nutritional deficiencies are present, vitamin D or calcium supplements may also be recommended.
5. Physical therapy
Physical therapy may be prescribed to stimulate bone healing and speed up recovery.
Treatment can include the use of low-intensity pulsed ultrasound devices, which promote bone repair and improve local circulation.
6. Surgery
Surgery may be necessary in cases with a high risk of joint displacement or when the bone fails to heal properly.
During surgery, the doctor may stabilize the bone with pins, metal plates, or screws.
Surgery is typically recommended for stress fractures in the femoral neck, anterior tibia, navicular bone, sesamoid bones, or metatarsals.