Stress Fracture – Lower Leg

A stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.


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A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:

  • Increasing the amount or intensity of an activity too quickly (most common)
  • Switching to a different playing or running surface
  • Wearing improper or old shoes

Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

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A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a stress fracture include:

  • Sex: female
  • Certain sports, especially involving jumping or running:
    • Tennis
    • Track, especially distance running
    • Gymnastics
    • Dance
    • Basketball
  • Amenorrhea (women only)
  • Reduced bone thickness or density
  • Poor muscle strength or flexibility
  • Overweight or underweight
  • Poor physical condition

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Symptoms include:

  • Localized pain on the bone
  • Pain when pressure is applied directly over the fracture and the area around it
  • Pain when putting stress on the affected leg
  • Swelling and warmth at injury site

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The doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling. Tests may include:

  • X-ray — to look for break in the bone (stress fractures are very tiny and usually not seen on an x-ray until at least two weeks after symptoms begin)
  • MRI scan — to look for swelling and inflammation inside the bone
  • Bone scan — to look for evidence of a stress fracture

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Rest is the first thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks. Once you are ready to restart activity, your physician may prescribe physical therapy. The following is a common progression for physical therapy treatment:

  • Begin with non weight–bearing activities, such as swimming, cycling, use of an Alter-G treadmill, etc.
  • Next, weight-bearing, nonimpact exercise may be prescribed.
  • Gradually, low-impact activity, starting with walking will be added to your treatment.
  • Once you can do fast-paced walking with no pain, your physical therapist will give higher impact activities, such as light jogging.
  • This gradual progression will continue until you have reached your pre-injury activity level and no longer feel tenderness of the bone.

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To reduce your chance of getting a stress fracture:

  • Wear proper footwear.
  • Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
  • Gradually increase the amount and intensity of an activity.
  • Do not overdo any activity.
  • Weight reduction can reduce stress on the bones
  • Avoid smoking.

This content was created using EBSCO’s Health Library

This content was created using EBSCO’s Health Library
  • American Academy of Orthopaedic Surgeons

  • American Orthopaedic Society for Sports Medicine

  • American Podiatric Medical Association

  • Canadian Orthopaedic Association

  • Canadian Orthopaedic Foundation

  • Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med . 2001;11:73-76.
  • Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician . 2003;68(8):1527. Available at .
  • Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: . Updated October 2007. Accessed June 25, 2008.
  • Stress fractures. Mayo Foundation for Medical Education and Research website. Available at: . Updated November 3, 2006. Accessed June 25, 2008.
  • Wells CL. Women, Sport & Performance: A Physiological Perspective . Champaign, IL: Human Kinetics; 1991.
  • Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med . 2005;39:65-69.

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