Stress Fractures
A stress fracture is a small crack in a bone caused by repetitive stress or overuse, rather than a single traumatic event. They most often occur in the foot, ankle, or lower leg, especially in athletes, runners, dancers, and military recruits. Stress fractures develop when the muscles become fatigued and can no longer absorb repeated impact, transferring excessive force to the bone. If untreated, stress fractures can worsen into complete fractures.
Diagnosis of Stress Fractures
Stress fractures are often diagnosed through:
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Medical history review (training intensity, recent activity changes, prior injuries).
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Physical exam checking for localized tenderness and swelling.
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Imaging tests:
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X-rays may not show stress fractures in early stages.
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MRI or bone scans are more sensitive for detecting microfractures.
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CT scans may be used for severe or complex cases.
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Treatment for Stress Fractures
Physical therapy plays a key role in recovery after immobilization or activity restriction. Treatment may include:
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Activity modification: temporarily avoiding high-impact activities
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Pain management with ice, ultrasound, or electrical stimulation
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Strengthening exercises for the surrounding muscles once cleared
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Flexibility training to reduce stress on the affected bone
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Balance and stability training to improve gait mechanics
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Education on footwear, training adjustments, and safe return-to-sport progression
Severe stress fractures may require a walking boot, cast, or even surgery in rare cases. PT helps restore strength and function afterward.
Symptoms of Stress Fractures
Common symptoms of a stress fracture include:
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Localized pain that worsens with activity and improves with rest
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Tenderness when pressing on the injured area
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Mild swelling around the site of the fracture
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Pain that increases during weight-bearing activities (running, jumping, walking long distances)
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Progression from dull, aching pain to sharp, persistent pain if untreated
Prevention of Stress Fractures
To reduce the risk of stress fractures:
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Gradually increase activity levels instead of making sudden jumps in training intensity
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Wear proper footwear and replace shoes regularly
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Cross-train with low-impact activities (cycling, swimming) to reduce repetitive stress
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Maintain good nutrition, including adequate calcium and vitamin D for bone health
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Strengthen leg, hip, and core muscles to absorb impact
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Rest and address minor pain early before it progresses