Stress Fracture – Causes and Treatment

Stress Fracture – Causes, Symptoms and Treatment


Stress fracture represents a small crack which does not fully penetrate a bone that is usually located in the lower part of the body, where all the bodyweight is borne. Most typically, stress fractures appear in the tibia (the shin bone) and the metatarsals (the small bones which form your foot, just behind your toes).  This injury is primarily described as one which occurs due to the overuse of the bone through continued application of effort and stress, through a sudden change in the physical activities (whether leisure or job related). It is most frequently encountered in athletes who practice running or jumping.

Stress Fracture - Causes Symptoms and Treatment

Detailed Presentation of the Causes and Symptoms of Stress Fracture

For athletes the repeated effort and strain during training and competitions is the main cause of the occurrence of stress fractures. This type of injury can be favoured by two particular aspects: a sudden change in the type of training (switching from 5k running to 10k or semi-marathon) and a weak structure of the bone itself (the precursor to osteoporosis).


The symptoms of stress fractures are quite wide ranging, and depend a lot on the pain tolerance of each individual. The main symptom is pain which develops while running and stops without any other intervention while resting. This is one of the most important ways in which you can differentiate stress fracture from shin splints, because the two types of injuries are located in the same area of the leg and have similar symptoms at the onset.


However, as the stress fracture progresses (if left untreated), the pain will become more focalised in a small area of the bone. For seasoned athletes, even this may not be sufficient reason to stop exercising and seek medical help. As a classic example, two professional runners have performed medal-winning Olympic events with a stress fracture: Frank Shorter in Montreal 1976 (silver medal in the marathon race) and Dave Johnson in Barcelona 1992 (bronze medal for the decathlon).


However, the pain will increase in intensity during running and will not stop altogether even during periods of rest. At the same time, you will notice swelling and tenderness in the area of the stress fracture.


Prognosis for Severe Cases

There are two critical reasons why you should not ignore stress fractures. One of them is that, in some cases, the outcome is malunion (improper alignment of the bones in your foot after treatment) or even non-union (failure of the bones to reconnect or for the crack in the bone to fully heal). These conditions potentially lead to chronic pain and even abandoning your athletic career.


The other reason is that stress fracture usually requires a long recovery period (between four and six weeks), while severe cases require surgery, sometimes the placement of medical screws to repair major damage to the bone (as was Dave Johnson’s case) and an even longer period away from the running track.


Treatment Courses

Since overexertion is the main cause of stress fractures, rest is the most important way of healing. After the doctor diagnoses this type of injury through X-rays or a more detailed CT scan of your leg, you should refrain from all sorts of physical efforts which involve putting pressure on the injured leg for a period of minimum one month and maximum 6-7 weeks.

At the same time, you will probably be prescribed calcium and vitamin D supplements to help heal the cracked bone faster. As for the immobilisation of the leg, this is usually not necessary. You may be required to wear a stiff shoe insert (a bootwalker) or, in more serious cases, to wear a short cast or use crutches while walking.



For athletes, who are subjecting their legs and feet to intense effort, a proper diet and adequate running shoes are two key elements in preventing the occurrence of stress fractures. You should include the recommended daily intake of calcium and vitamin D from natural sources in your diet or take supplements if necessary (as your doctor or coach advises), as a preventive measure not only for running injuries but also against the occurrence of osteoporosis in later years.

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