Stress Fractures
A stress fracture is a small crack in a bone that happens because of repeated pressure or overuse, rather than a single injury. Imagine wiggling a metal paperclip back and force until it eventually breaks. This is akin to how a stress fracture develops. It’s often caused by doing too much physical activity too quickly, especially in sports that involve running, jumping, or repetitive motions. Stress fractures are commonly in weight-bearing bones like those in the legs and feet, especially the shin bone, or certain bones in the foot. Specifically, stress fractures occur in bones, or areas of a bone, where the force from each movement is concentrated -and the rate of microscopic breakdown (injury) of bone exceeds the body’s ability to heal the injury.
People who are more likely to get stress fractures include athletes, especially runners, dancers, and soldiers who do a lot of marching. Stress fractures often occur in people who suddenly increase their physical activity, wear improper footwear, or have weaker bones due to conditions like osteoporosis. Rest and reducing activity for a period of weeks is usually needed to allow time for the bone to heal.
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Location of Common Stress Fractures
A stress fracture commonly occurs in a bone that bear a lot of weight, especially during activities like running, jumping, or other high-impact sports. A person’s individual anatomy (ex. foot shape) often determines exactly where a stress fracture will occur. The most common bones affected by stress fractures include:
- Tibia (shin bone) – The most frequent site of stress fractures, especially in runners. Stress fractures typically develop on the inner (medial) side of the tibia because this part of the bone is subject to repetitive loading with each stride.
- 2nd and 3rd Metatarsals (foot bones) – These are the long bones in the foot which take a lot of pressure during walking or running. The location of a metatarsal stress fracture is dictated by how the shape of the foot absorbs force with each step. Typically, a long second metatarsal bone (or less commonly the third metatarsal) is often seen in patients with flatfeet or bunions. An overly long metatarsal will be subject to a disproportionate amount of force going through the metatarsal with each step predisposing to the development of a stress fracture.
- Proximal 5th Metatarsal (Jones-Type Fracture) – The base of the fifth metatarsal on the outside of the foot is another common location for a stress fracture. However, unlike stress fractures of the second and third metatarsal these Jones-type stress fractures typically occur in individuals with high arched (cavus) feet. This is because this foot-shape tends to concentrate force in the outside of the foot during walking or running.
- Fibula (outer lower leg bone) – Often affected in athletes who do a lot of running or dancing. These fractures tend to occur in the fibula (the outer bone of the lower leg) because in some individuals this bone is subject to excess repetitive force when the ankle or hindfoot abuts up against the fibula during various movements such as running and jumping.
- Navicular bone (a bone in the middle of the foot) – Common in sports that involve jumping. Navicular stress fractures typically occur in individuals with a stiffer foot such as a high arched foot, or a foot with a tarsal coalition. Limited motion through the talonavicular joint (part of the transverse tarsal joint which gives the foot mobility) tends to cause the navicular to be struck in the same location which each step predisposing to a stress fracture.
- Femur (thigh bone) – Specifically, the neck of the femur (near the hip) can develop stress fractures, especially in long-distance runners. These stress fractures commonly develop on the inner (medial) side of the femoral neck which is subject to repetitive compression forces with each step. Female runners with osteoporosis are at particular risk of femoral neck stress fractures.
- Pelvis – Less common, but can occur in athletes like distance runners or military recruits.
These bones are more likely to develop stress fractures because they receive concentrated repetitive loads due to repeated impact and pressure from physical activities –especially if someone suddenly increases the intensity or duration of their exercise.
How a Stress Fracture is Diagnosed
A stress fracture is diagnosed by a doctor through a physical exam and by asking about any recent activities that could have caused the injury, like sports or increased exercise. The doctor will look for areas of tenderness or swelling. To confirm the diagnosis, imaging tests are often used. X-rays are usually done first, but stress fractures don’t always show up on an X-ray, especially if the fracture is small or early on. If the X-ray doesn’t show a fracture but the pain continues, doctors might use more detailed imaging like a bone scan or an MRI. A bone scan can show areas of bone healing, which can indicate a stress fracture, while an MRI provides a clear picture of both bones and soft tissues, making it easier to see small cracks in the bone. These tests help the doctor figure out the best way to treat the injury.
Treatment of Stress Fractures
A stress fracture is typically treated by resting the injured area to give the bone time to heal. This means stopping the activities that caused the stress fracture, like running or jumping, until the fracture has solidly healed –often many weeks. Doctors might recommend using crutches to take weight off the injured leg or foot, or even a special walking boot or brace to keep the bone stable. Ice can help reduce swelling and pain, and over-the-counter pain relievers like ibuprofen can also help. In more severe cases, a cast might be needed, or very rarely, surgery to fix the bone. The stress fracture is an actual microscopic fracture of the bone so adequate healing of the fracture often takes many weeks. Once the pain goes away, doctors usually suggest a gradual return to activity to prevent the fracture from coming back. If the stress fracture was associated with an underlying weakness of the bone from a condition like osteoporosis it is important to treat this condition in addition to treating the stress fracture. Failure to address the reasons why the stress fracture occurred will notably increase the chance of the stress fracture failing to heal or recurring in the future.
Edited by Stephen Pinney MD, April 27th 2026.