What is a Stress Fracture?

What is a Stress Fracture?

Stress fracture of the foot

A stress fracture is a tiny crack in the bone caused by overuse or repetitive trauma. When muscles get too fatigued, they can’t absorb the forces of exercise. These forces then get redistributed to the skeleton and can quickly overcome the structural integrity of your bones, leading to hairline fractures.

Habitual long-distance running or repetitive jumping can cause stress fractures, which are common among professional athletes. But anyone can develop a stress fracture—all it can take is a new exercise routine to place stress on a bone.

Types of Stress Fractures


A stress fracture can occur in weight-bearing bones such as the hips, ribs, shins, and feet. Common types of stress fractures include:

  • Metatarsal stress fracture –These fractures occur within the long bones of your feet, connecting the toes to the ankle. This kind of fracture in the foot can be caused by continuous athletic activities and is common among runners, gymnasts, and dancers. 
  • Navicular stress fracture – The navicular bone, a boat-shaped tarsal bone in the middle of your foot, takes a lot of pressure during physical activities. The lack of blood flow to the area makes minor injuries more difficult to heal, making the navicular prone to fractures.
  • Tibia stress fracture – A stress fracture in the shin area. This part of the leg is susceptible to fractures due to continued stress from activity (for example, habitual long-distance runs on hard pavement).
  • Fibula fracture – Like the tibia, the fibula is a weight-bearing bone in your lower leg. Repeated impact can wear down the bone, resulting in cracks from overuse. 
  • Rib stress fracture – Cracks can occur in the bones of the rib cage. Potential causes include damage from a fall, a traumatic impact during a sports activity, or a car accident. 

Stress fractures are most common in the feet and lower legs — the metatarsal, navicular, tibia, and fibula bones. Fractures can also occur to the femur (upper leg), wrist, pelvis, hip, and spine. However, stress fractures can occur anywhere when muscle overuse and skeletal overloading are involved.

Signs & Symptoms of Stress Fractures


Stress fracture symptoms can be mild at first—known as what’s called a ‘stress reaction’. But stress reactions can worsen if not addressed right away. Signs of a stress reaction can begin with tenderness or pain in a particular spot that decreases with rest. 

Stress reactions can cause mild discomfort to severe pain and swelling around the area. When a stress fracture occurs, it often becomes difficult or impossible to exercise, depending on the injury location.

Stress fracture symptoms can include: 

  • Swelling, aching, or pain at the fracture point
  • Pain and tenderness when you touch the bone 
  • Pain that flares up during physical activity and subsides when resting
  • Continual pain during physical activity and afterward 
  • Resting pain (discomfort while inactive or performing everyday activities, such as walking)
  • Pain that worsens when hopping or shifting your weight onto the affected foot/leg

What Causes Stress Fractures?


A stress fracture in the bone is caused by repetitive force or overuse. If you introduce a new exercise program into your life which your bones aren’t used to, or increase the intensity of an activity too quickly, the muscles surrounding the bone may not be able to absorb the impact, resulting in transferred pressure on the bone.  

A number of sports and high-impact activities can lead to stress fractures, including:

  • Soccer
  • Long-distance running
  • Tennis
  • Basketball
  • Gymnastics
  • Track and field activities
  • Ballet and other forms of dance 

Stress fractures don’t just happen to dancers and athletes. Tiny cracks in the bone can occur due to a change in routine or other factors, such as:

  • Practicing a training or exercise program with improper form
  • Introducing a new exercise program without proper muscle build-up
  • Ramping up your training before your body is ready
  • A change in your exercise surface, like switching from a softer indoor track to hard, outdoor pavement or gravel
  • Running on an inclined surface
  • Improper footwear, such as worn-out or unsupportive running shoes

Risk factors

Risk Factors

In addition to sports, additional factors may increase the risk of a stress fracture, including: 

  • Foot conditions - If you have high, stiff arches, bunions, or flat feet, this could increase your risk of a stress fracture. Unsupportive footwear can also contribute to the problem. 
  • Osteoporosis - Stress fractures can more easily develop in bones that are weakened by this condition
  • Nutrient deficiency - When your body doesn’t get proper nutrients and vitamins, such as calcium and vitamin D, the result can be weakened bones that are more prone to stress fractures
  • Previous stress fractures - If you’ve had one stress fracture, you are at a higher risk of having another
  • Gender - Women, particularly those with osteoporosis, irregular periods, or experiencing menopause, can be at a higher risk
  • Age - Older people may be more at risk due to osteoporosis or other bone density conditions

Left untreated, complications from stress fractures that do not heal properly can cause chronic problems. If you suspect you have a stress fracture, it’s important to consult a doctor as soon as possible.

Preventing Stress Fractures


Even if you are an athlete or in a higher risk category for developing a stress fracture, there are preventive measures you can take to reduce your likelihood of getting one, including: 

  • Stop exercising if you feel pain. Don’t resume until the pain disappears.
  • When beginning a new workout routine or sports activity, start slowly. Increase the intensity incrementally to give your body a chance to strengthen. 
  • Be mindful of running with proper form
  • Avoid continually jogging on hard surfaces like concrete
  • Warm up and cool down before and after activities
  • Wear proper, supportive footwear
  • Follow a diet rich in vitamin D (at least 1,000-2,000 units/day) and calcium to support healthy bones
  • Consider integrating low-impact activities, like swimming or gentle yoga, into your routine to give parts of your body a break
Get Care

Trust NewYork-Presbyterian for Stress Fracture Care

The doctors at NewYork-Presbyterian recognize how painful and disruptive a stress fracture can be. Don’t ignore the pain—without treatment, stress fractures can heal improperly and lead to more serious problems, such as arthritis, or require surgical correction.

Our experts are here to provide a professional diagnosis and treatment options to have you back up and running. 

For compassionate and quality care, reach out to NewYork-Presbyterian for an appointment.