Stress Fracture Injuries

Stress Fracture

A stress fracture is a tiny crack in the surface of a bone.

Stress fractures can occur when runners increase the intensity and volume of their training. Muscle soreness and stiffness progress over this period and pinpoint pain develops on the sore bone. Stress fractures are one of the most common and serious running injuries. In fact, 80% of occur in the legs.

Different Kinds of Stress Fractures

For runners, stress fractures typically present in the foot (metatarsals), shin (tibias), or heel (calcaneus). Here’s how these fractures manifest in different areas of the leg and foot.

According to the American Academy of Orthopaedic Surgeons, “stress fractures occur most often in the second and third metatarsals in the foot, which are thinner (and often longer) than the adjacent first metatarsal. This is the area of greatest impact on your foot as you push off when you walk or run.”

Stress Fractured Foot

The most common cause of stress fractures in the foot is a sudden increase in physical activity. This increase can be in the frequency of activity—such as exercising more days per week.

Stress Fractured Ankle

Stress fractures are common in the calcaneus (heel). The fibula (the outer bone of the lower leg and ankle), Talus (a small bone in the ankle joint), and the navicular (a bone on the top of the mid-foot).

Even for non-athletic folks, a sudden activity increase can cause a stress fracture. For instance, if don’t walk regularly on a day-to-day basis but start walking excessively (or on uneven surfaces) while on a vacation, you may get a stress fracture. 

Stress Fractured Shins

A stress fracture of the shin is a thin break typically caused by repetitive, high-impact exercise.

Overuse and minor injuries can result in a stress reaction or deep bone bruise. If you start to feel shin pain, cut back your exercise routine, and allow time for healing. Continued pressure on the bone can make it start to crack, resulting in a stress fracture.

Stress fracture heel

A stress fracture that occurs in the heel is due to abnormal stress that has been placed upon it.  The most common presentation is with a sudden alteration in the training regimen, (more sprinting, increased mileage, or increased training intensity) that develops global pain around the heel.  Swelling may or may not be seen with this problem.  This type of injury is more common in women, especially those with menstrual irregularities and lower calcium intake.   


The most common symptom of a stress fracture is pain. The pain usually develops gradually and gets worse during any weight-bearing activity. Other symptoms may include:

  • Pain that intensifies during normal activities
  • Swelling.
  • Tenderness to touch at the site of the fracture
  • Possible bruising

Stress Fracture Treatment

Treat with ice and anti-inflammatories. Keep in mind that stress fractures are not a self-diagnosis/ self-treatment type of injury. A proper x-ray or bone scan is necessary to prescribe treatment. Depending on the location of the fracture, recommendations may differ. Consult your doctor about appropriate cross-training activities.

Stress Fracture Surgery

Some stress fractures are more severe and require surgery to heal properly. In many cases, this involves supporting the bones by inserting a fastener, called internal fixation. Screws, and/or plates are most commonly used to hold the small bones of the foot and ankle together in the recovery process.

Preventing Stress Fractures

The following preventative measures can help you prevent stress fractures in the future.

  • Start eating a healthy diet. A balanced diet rich in Vitamin D and calcium will build bone strength.
  • Run in good shoes. Old running shoes tend to lose their ability to absorb shock which can lead to injury.
  • Start new activity gradually. Increase your time, speed, and distance gradually.
  • Do Cross-training. Choose other activities to avoid overstressing one area of your body.
  • Add weight training. The best way to prevent fatigue and the loss of bone density that occurs naturally with aging is to incorporate strength training. Try free weights, resistance bands, or bodyweight exercises to build muscle and strength.
  • Stop if pain or swelling returns. Rest for a few days and if the pain continues, see your doctor.