A stress fracture is most commonly seen in the tibia but can occur in many other bones. The majority of stress fractures are seen in runners, with females being 12 times more likely to develop stress fractures. This is thought to be secondary to the smaller size of the bone, their menstrual irregularities, and the higher incidence of eating disorders. The development of a stress fracture is multifactorial. They can occur in the highly trained athlete or a recreational novice. The cause is typically a change in training whether it is an increase in intensity or duration, change in footwear or surface, or an anatomical abnormality. Prior to puberty, stress fractures are thought to be uncommon, but after puberty, the incidence is the same as in the adult population.

Will x-rays be taken?
Usually x-rays are taken to identify a stress fracture. Not all stress fractures will show up on plain x-rays. Sometimes a bone scan or an MRI will be ordered.

How are stress fractures treated?
Relative rest is the treatment of choice, meaning any activity that causes pain should be avoided. Walking with crutches helps to reduce stress on the bone. When the patient can walk comfortably, they can come off of the crutches. When they can run, they can begin weight-bearing training. Until they are able to go back to regular activities, they may perform non-weightbearing exercises like bicycling and swimming.

What are the complications of a stress fracture?
A stress fracture that does not heal may become a true fracture that requires casting or surgery to heal. It is very important to allow a stress fracture to heal appropriately so additional time away from the patient’s sport is not required.