Stress Fractures

Medically Reviewed by Jennifer Robinson, MD on September 14, 2023
4 min read

Stress fractures are some of the most common sports injuries. They are tiny breaks in the bone, usually caused by repetitive stress from activities like running. Although they can be quite painful, they usually heal themselves if you rest for a few months.

Stress fractures usually cause dull pain around the site of the fracture. This pain usually gets worse while exercising, walking, or standing. Another symptom is swelling in the area.

Many sports raise the risk of stress fractures. Activities that require running and jumping may cause fractures in the legs or feet. More than half of all adult and adolescent stress fractures occur in the lower leg bones. Of these, fractures of the tibia -- the long bone of our lower leg -- are the most common at about 24% of all stress fractures.

Other sports that require repetitive movements -- like pitching or rowing -- can result in stress fractures of the humerus (arm bone), but these are much rarer.

Stress fractures are much more likely to develop in people who have just started a new exercise or abruptly stepped up the intensity of their workout. When the muscles aren't conditioned, they tire easily and can't support and cushion the bones as well. More pressure goes directly on the bones, which can lead to a fracture.

Stress fractures seem to be more common in women. Other risk factors for stress fractures include:

Any anatomical abnormalities -- like fallen arches -- can distribute stress unequally through the feet and legs. This raises the risk of stress fractures. So can poor-quality equipment, like worn-out running shoes.

To diagnose a stress fracture, your doctor will give you a physical exam. Although they can be helpful, X-rays often can’t spot stress fractures. Your doctor may use MRIs, nuclear bone scans, or other imaging methods to diagnose you.

First aid for stress fractures

It’s important to see your doctor, because the bone could break completely without treatment. In the meantime, follow the RICE guidelines:

  • Rest. Avoid weight-bearing activities. Wear a stiff-soled, supportive shoe if necessary.
  • Ice. To ease swelling, ice the area for 24 to 48 hours. Wrap an ice pack in a towel and apply for 20 minutes at a time. Never put ice directly on your skin.
  • Compression. Wrap a soft bandage around the area to ease swelling.
  • Elevation. Use pillows to raise your foot or leg higher than your heart.

Medications for stress fractures

You can take over-the-counter medications to manage pain. Doctors suggest acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs), which may reduce your bone’s ability to heal.

Nonsurgical treatments for stress fractures

Most people don’t need surgery to repair a stress fracture. Along with the RICE plan to reduce pain, your doctor may try one or more of these treatments while your fracture heals:

  • Crutches or a cane for support
  • Protective footwear like a boot or brace to lessen stress on the fracture
  • Casts to keep your fracture in a fixed position while it heals

They’ll also advise you to skip high-impact physical activities like running for 6 to 8 weeks. Try lower-impact exercises like swimming or cycling instead.

Surgery for stress fractures

You may need surgery for severe stress fractures that won't heal on their own. Most often, the doctor will insert fasteners -- like pins, screws, plates, or a combination of these -- to hold the small bones of your foot and ankle together.

It usually takes 6 to 8 weeks for a stress fracture to heal. The doctor may take X-rays when the pain eases to be sure the fracture has healed.

When the swelling goes down to the point you can see skin creases, you can start putting a little weight on the area. You might still need to use crutches or a cane. It’s usually OK to put your full weight on the area 2 weeks after your symptoms started. Weight-bearing can help the stress fracture heal. But don't do anything that hurts.

For the next 6 to 8 weeks -- or until you're free of pain -- avoid the activity that caused the stress fracture, and avoid putting too much weight on the affected area. If you exercise again too soon, you could delay the healing process. You could even cause damage that may never heal properly.

Early on, the doctor may tell you to alternate active days. If you’re a runner, that means you’d rest the day before and after going for a jog.

Remember that if you rush back in, you could re-injure yourself. Stress fractures tend to repeat. About 60% of people who have a stress fracture have had one before.

Stress fractures often happen in people who have dramatically raised their level of physical activity. So to prevent them, go slowly. Experts recommend that you never increase your exercise intensity by more than 10% per week. Make sure to warm up and stretch for a few minutes before exercising. Take frequent breaks to give your body a rest. And if you feel pain during exercise, stop. Don't push through it. High-impact sports and work activities increase the risk for stress fractures.

Also, good exercise equipment can help prevent stress fractures. Don't wear worn-out running shoes. People who have fallen arches or other anatomical problems may benefit from custom inserts or arch supports in their shoes.