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.
Stress Fractures of the Tibia and Fibula
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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:
Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.
Stress fractures are more common in women. Other factors that may increase your chance of a stress fracture include:
A stress fracture may cause:
The doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling.
Imaging tests to evaluate your bones include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.
Rest is the most important 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.
You may need crutches or a walking cane to keep pressure off the leg.
Talk with your doctor about when you can restart activity and how to progress with the amount and type of activity.
A common progression:
American Orthopaedic Society for Sports Medicine
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Femoral stress fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2012. Accessed September 29, 2014.
March fracture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed September 29, 2014.
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):1527-1532.
Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 29, 2014.
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.
Last reviewed September 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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