A stress fracture is a small break in the bone. In a stress fracture, a thin crack develops from repetitive force, which is usually caused by overuse. Most stress fractures occur in the bones of the foot and lower leg, which carry the weight of the body.
The most common locations of stress fractures are the second and third metatarsals of the foot. Stress fractures are also common in the heel, in the outer bone of the lower leg, and in the navicular (a bone in the top of the foot). (See illustration.)
The bones of the foot
Stress fractures make up 2% of all sports injuries in athletes.
The symptoms of a stress fracture include the following:
If the stress fracture is not treated, the pain can become severe. The fracture can also become displaced (the fractured bone moves out of normal alignment)
When bones are involved in a new activity that can cause stress, such as a new exercise routine, they may have trouble adjusting. This can cause them to crack.
Other causes of stress fractures include the following:
If a stress fracture is not properly treated, serious problems may develop. For example:
During a patient's first visit to the doctor, the doctor will want to have a full understanding of the patient's risk factors for stress fractures. The patient will be asked about his or her medical history, work, activities, and the medications he or she is taking. The doctor will examine the patient's foot and/or ankle. The doctor may then schedule a follow-up appointment for further testing.
A stress fracture can be difficult to see on an X-ray, because the bone often appears normal in the X-ray, and the small cracks can't be seen. X-rays may not help diagnose a stress fracture unless it has started to heal. When the bone starts to heal, it creates a callus, or lump, that can be seen on X-rays. The doctors may recommend a bone scan or magnetic resonance imaging (MRI), which is more sensitive than an X-ray and can spot stress fractures early.
During a bone scan, a tracer (a radioactive substance) is injected into the patient's bloodstream. The tracer collects in the bone and settles in the areas where the bone is being repaired. The area that is affected by a stress fracture will appear darker on the bone scan than an uninjured area.
Magnetic resonance imaging
Magnetic resonance imaging (MRI) is a test that produces very clear pictures, or images, of the human body with a large magnet, radio waves, and a computer to produce these images.
A MRI is preferred in many cases because there is no radiation exposure, it takes less time, and it is better at diagnosing different types of bone and/or soft tissue abnormalities.
If you think you have a stress fracture, see your doctor and follow the treatment guidelines he or she gives you. Do not ignore the pain, because it can cause serious problems.
These are some of the treatments your doctor may recommend:
During the early phase of healing, the doctor may recommend that you change your schedule so that you rest one day, do an activity the next day, then rest the next day. You should slowly increase how often and how vigorously you exercise. If the activity that caused the stress fracture is resumed too quickly, you may develop a larger stress fracture that is harder to heal. If you re-injure the bone, it can lead to long-term problems, and the stress fracture might never heal properly.
Change the types of aerobic exercise you do to help avoid repeated stress on the foot and ankle. Switch to aerobic activities that place less stress on your foot and leg so that the stress fracture can heal properly. Swimming and cycling are good alternative activities.
As long as you can feel pain, the bone is still fragile in that area, and can break again in the same place. It takes 6-8 weeks for a stress fracture to heal, so it is important to stop the activities that caused the stress fracture. Always ask your doctor before you do any physical activity on the injured foot or ankle.
These steps can help prevent a stress fracture:
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 06/17/2015