Stress Fracture: Symptoms, Treatment and When to Rest

Bone is living tissue that constantly repairs itself. When it takes the same impact over and over without enough time to recover, the repair process falls behind and a small crack can form.

Stress fractures happen most often in the weight-bearing bones of the lower leg and foot, such as the shin, the metatarsals in the front of the foot, the heel and the ankle. They can also occur in the hip and, less commonly, in the arm or back.

Runners, dancers, gymnasts, basketball players and military recruits are at higher risk, but you do not have to be an athlete. A sudden jump in walking, a new job on your feet or a change in shoes or surface can do it too.

The classic sign is pain that builds during activity and eases with rest. At first it may only hurt when you run or jump. Over time it hurts during normal walking, and then even at rest or at night.

You may notice tenderness when you press on one specific spot on the bone, along with mild swelling. Bruising is less common. Pain that stays in one exact place, instead of spreading across a muscle, is a clue that it may be a bone problem.

Not all stress fractures are the same, and the exact bone matters. Some, like those in the shin or the front of the foot, usually heal well with rest from impact. Others, like certain spots in the hip or the top of the foot, have a weaker blood supply and need closer attention. That is another reason a persistent, focused pain should be looked at by a doctor and not just waited out.

Stop the activity that causes the pain. Pushing through can turn a small crack into a complete break, which is harder to treat.

Rest the area, avoid high-impact movement, and use ice and over-the-counter pain relievers if your doctor says they are safe for you. Switch to low-impact exercise that does not hurt, such as swimming or cycling, if your doctor agrees. Then book an exam.

Your doctor will ask about your activity, examine the painful spot and usually order an X-ray. Early stress fractures sometimes do not show up on the first X-ray, so your doctor may recommend follow-up imaging if symptoms continue.

Most stress fractures heal without surgery. Treatment often means a period of rest from impact, sometimes with a walking boot, brace or crutches to take weight off the bone. The time needed depends on the bone and how severe the crack is. A few higher-risk locations, such as certain bones in the hip or foot, may need closer monitoring or surgery.

Returning too soon is the most common mistake. Your doctor will guide you on when to restart, usually adding activity slowly and watching for pain. Reviewing shoes, training habits, nutrition and bone health helps prevent another one.

Bone health plays a part as well. If you have had more than one stress fracture, ask your doctor whether your vitamin D, calcium intake or overall nutrition should be reviewed. Women and men who train hard and do not eat enough to match their activity are at higher risk, and fixing that can protect your bones.