Stress Fractures

By Ryan Hudson, MD

Could your foot or leg pain be an overuse injury that warrants an extra rest day or something more serious – like a stress fracture?

A stress fracture is a fairly common, yet potentially serious, condition that typically involves the leg bones (the tibia, fibula and femur) of distance runners. The injuries are caused by repetitive stress and impact, which creates a mismatch of bone formation and bone destruction. This imbalance typically happens when a runner has sudden changes in training, such as a rapid increase in distance, speed, or duration of a workout. Runners are especially susceptible when their bones, joints, muscles, and ligaments are fatigued or under-conditioned.

Stress fractures tend to cause localized pain at the site of the injury. Depending on the severity of the fracture, the pain may not be constant. Instead, it usually develops and worsens throughout exercise. Meanwhile, making the diagnosis can sometimes be difficult because x-rays are often unreliable in these cases. In fact, research has shown that X-rays are “negative” for 66 percent of early stress fractures. To get the most reliable diagnosis, patients will typically need a nuclear medicine bone scan or a MRI.

Treating a stress fracture depends whether it’s located in what’s considered a “critical” or “non-critical” location. That’s because the ability to heal a stress fracture depends on several factors, including the physical forces at the site and blood flow, which supplies energy needed for bone formation. Critical stress fractures include fractures of the femoral neck (hip), anterior tibia (leg), medial malleolus (ankle), navicular (foot), and 5th metatarsal (foot) bones. Runners who wind up with these injuries often have to stop weight-bearing activities, get a cast and sometimes even undergo surgical stabilization to heal the fracture and prevent it from becoming unstable. For non-critical stress fractures, physicians typically prescribe rest followed by progressive, controlled exercise and monitoring to heal the fracture site.

The best ways to avoid stress fractures means not pushing yourself until your body is ready. Instead, runners should slowly and gradually increase distance, speed, duration, and running on different types of terrain. It’s also important to have proper nutrition, because that gives your body the energy it needs for proper bone recovery. And don’t forget to make sure you’re wearing the right footwear.