The most basic explanation of a stress fracture is that a bone, usually a weight-bearing bone in the leg or foot, has developed a small crack.
Even though it may only be a tiny fracture, it can cause all sorts of big problems, including pain, swelling, or even bruising. Even a small stress fracture can seriously diminish a person’s ability to play sports, perform on the job routines, or just accomplish day-to-day tasks.
Anyone can suffer from stress fractures. While athletes and those with physically demanding jobs are sometimes at greater risk of this condition, people who are moderately active, as well as those with sedentary lifestyles, can develop this condition.
That’s why understanding the causes, symptoms, and the best treatment approaches for stress fractures can help anyone who may be dealing with this injury to identify it, address it and, ultimately, lessen downtime and speed up recovery.
What is a Stress Fracture?
A stress fracture is a tiny crack in a bone caused by overuse or a repetitive force that usually develops in the foot or lower leg, although it can occur anywhere in the body.
The bones in the lower legs and feet are most susceptible to a stress fracture because they are the physical structures sustaining the weight and strain of daily impact.
Stress fractures in longer, thinner bones, like the second and third metatarsals located on the top of the foot, are also especially common. That said, a stress fracture in the ankle, heel, and the navicular bone in the upper mid-foot are also quite common.
Although a foot stress fracture is the most common location, any bone in the body is susceptible. What can be problematic with these injuries is that they might not be immediately noticeable.
Even though stress fractures are one of the most common running injuries, athletes of all types who perform repetitive movements are susceptible to bone fractures caused by stress from playing or working out.
Beginners or younger athletes sometimes transfer the load to the bones if they have not developed significant muscle strength to absorb the shock.
Aches and pains are common for athletes and people who are regularly active and there is sometimes a tendency to try to ignore or work through the pain, which can worsen the symptoms of a stress fracture.
Despite the fact they may share some common symptoms, they should not be confused with a bone spur, which is a completely different condition.
What are Common Stress Fracture Symptoms?
Pain in the affected bone or area is the most common symptom of a stress fracture. This is why it’s important not to simply brush off pain in the lower-legs or feet, because it can potentially become a stress fracture or aggravate one even further.
While discomfort in the bone may start as mild, stress fracture pain will increase over time, gradually becoming worse with activity and when weight is placed on the injured bone or bones.
It may also lead to some of the following:
- Swelling in the affected area, or pain on top of the foot or outside of the ankle with a stress fracture in the foot
- Tenderness to the touch
- Discoloration and bruising around the injury
- Pain that intensifies throughout the day or with specific activities
- An easing of the pain when weight is taken off the fracture or when activity is decreased
High-impact activities, like running, jumping, sprinting, and quick stops and starts can often lead to a stress fracture. There are other specific issues, which some people might not automatically consider, that can also cause the injury.
Causes and Prevention of Stress Fractures
More often than not, a stress fracture is caused by a swift increase in activity. For athletes, this might mean a series of back-to-back competitions. For another person, it may be working several overtime shifts. Simply increasing the duration or intensity of an exercise regimen can also lead to a stress fracture.
Overuse or over-training, especially when coupled with poor training or vocational techniques, can also put stress on weak bones and cause a fracture.
There are some conditions, like osteoporosis, that lead to weak or poor bone density increasing the risk of a stress fracture. Some medications are known to weaken bones and put a patient at-risk of stress fractures.
Some injuries are more common in the winter when people spend fewer hours in the sunlight and have less vitamin D in their bodies.
In order to help prevent a stress fracture, it’s important to follow a few simple guidelines.
Tips for Preventing a Stress Fracture
1. Don’t Do Too Much Too Soon
Go slowly when increasing training intensity and duration. This applies to people at all activity levels, from those simply opting for a healthier lifestyle to professional and amateur athletes.
2. Take Time to Warm Up
Warming up first is always important, but it is particularly necessary when working or playing on different surfaces. Moving around on grass is much different from moving around on a harder surface, such as concrete.
3. Learn Proper Techniques
Whenever possible, learn the proper technique for whatever activity you’re participating in, whether that’s construction or manufacturing work, or competing in any type of sport.
4. Use Appropriate Footwear
Always wear proper and supportive footwear that’s appropriate for the specific movement. This also means regularly updating footwear as it wears down and becomes less supportive.
Effective Stress Fracture Treatment Methods
If you think you may be suffering from a stress fracture, it’s important to stop all activities that are causing pain or symptoms and see a doctor as soon as possible.
Diagnosing a stress fracture will include a physical exam, a discussion of recent activity, prior medical history, current medications, as well as imaging, such as x-rays or an MRI.
Conservative treatment approaches are usually the first step in addressing stress fractures, which simply provide the injury time to rest and heal.
Stress fracture treatment approaches can include:
1. The RICE Method
The RICE Method is a conservative treatment approach that works well for many injuries including stress fractures. RICE stands for Rest, Ice, Compression, and Elevation.
Resting the injured area decreases the chances of greater injury and allows it time to heal. The application of ice or a cold pack can help reduce swelling and pain. Compression helps stabilize the injured area, and elevating the injured area above the heart reduces blood flow and minimizes swelling.
2. Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications, like ibuprofen (Advil) or naproxen (Aleve) can also help ease pain and inflammation during the RICE protocol. These types of medications are available over the counter and do not require a prescription.
3. Foot Brace for a Stress Fracture
A Walking Boot or Foot Brace for a Stress Fracture will provide additional support and restrict movement during the healing phase of the injury to help with recovery.
Using crutches, a walking stick, or a cane in combination with a foot brace or walking boot will further relieve stress and impact, and should be enough to avoid requiring a more obtrusive cast.
4. EPAT Therapy / Shockwave Therapy
EPAT Therapy, often referred to as Shockwave Therapy, is an extremely effective noninvasive method for speeding up recovery from a stress fracture.
Shockwave Therapy delivers sends targeted energy pulses to the affected area to stimulate the cells responsible for healing the bone and the associated connective tissue.
EPAT is widely known to reduce downtime, improve recovery time, and is now being used effectively by many sports medicine doctors and trainers at the college and professional sports levels, like the NFL, NBA, and Major League Baseball.
5. Physical Therapy
Physical Therapy is often a good treatment approach for two reasons. First, it helps strengthen the muscles and other soft-tissue surrounding the healing bone, which will aid in preventing further injury.
Second, it provides an opportunity to learn proper movement techniques.
EPAT / Shockwave Therapy and Physical Therapy are often combined to deliver faster healing results.
6. Surgery for Stress Fractures
Most stress fractures will heal on their own if proper precautions are taken like resting and alleviating any weight or load on the injury. In the case of a severe stress fracture that doesn’t heal in due time, or it is not possible to rest it, surgery may be required.
When this is the case, surgery usually involves using a screw, pin, or a plate to stabilize the bone so it can heal effectively.
Surgery is always a last resort because it includes a more significant recovery time and rehab. It also comes with other risks that should be discussed thoroughly with your physician.
Many athletes and avid runners understand injuries will happen at some point, so practicing proper prevention techniques can minimize them.
If an injury like a stress fracture does occur, resting it while incorporating some of the treatment approaches outlined here can speed up the recovery process.
It can take 6 to 8 weeks for many stress fractures to completely heal, so the earlier a person begins treatment, the faster the injury will recover.
Photo Credit: Stress fracture x-ray image by James Heilman, MD