Stress fractures

Stress fractures are tiny cracks in bones often caused by overuse or osteoporosis. Learn how to prevent and treat them.

Update Date: 25.04.2025

Overview
Symptoms
When to see a doctor
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Self care
Preparing for your appointment
Overview
Symptoms
When to see a doctor
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Self care
Preparing for your appointment

Overview

Stress fractures are tiny cracks in a bone. Repeated stress to the bone causes them. The stress often comes from using the same body part too much. Some examples include jumping up and down a lot or running long distances. Stress fractures also can happen with regular use of a bone that's weaker due to a condition such as osteoporosis.

Stress fractures are most common in the weight-bearing bones of the lower leg and foot. People at highest risk of this injury include runners and gymnasts. Military recruits who carry heavy packs over long distances also have a high risk. But anyone can get a stress fracture. You might get this injury if you start a new exercise program or sport, and you do too much too soon.

Stress fracture

Stress fractures are tiny cracks in a bone — most commonly, in the weight-bearing bones of the lower leg and foot.

Symptoms

At first, you might barely notice the pain from a stress fracture. But it tends to become worse if you do more of an activity that puts stress on the cracked bone. The tender feeling often starts at a certain spot and gets better during rest. You also might have swelling around the painful area.

When to see a doctor

Call your doctor if you have ongoing pain. Get help as soon as possible if you feel pain even when resting or at night. When people with stress fractures get treatment early, they're more likely to recover faster. And they're less likely to have complications.

Causes

Stress fractures often happen when you increase the amount or intensity of an activity too fast.

Bone can adapt to greater amounts of stress, but it needs time to do so. During a lifelong process called remodeling, old bone tissue is destroyed and then rebuilt. This process speeds up when the weight-bearing load on the bone increases.

The risk of a stress fracture rises when a bone bears an unusual amount of force without enough time to recover. Bone tissue is destroyed faster than the body can replace it.

Risk factors

Factors that can raise your risk of stress fractures include:

  • Specific sports. Stress fractures are more common in people who do activities that put a high level of repetitive stress on joints. These include track and field, cross-country running, basketball, tennis, dance and gymnastics.
  • More activity. Stress fractures often happen in people who suddenly shift from an inactive lifestyle to a training routine. People who quickly raise the intensity, length or number of training sessions they do also put themselves at risk.
  • Female sex. Athletes who were born female seem to have a higher risk of stress fractures than those born male. The higher risk may be linked to not getting enough nutrition to support training demands. This can result in irregular menstrual periods and a condition that involves thinning bones, called osteoporosis. Sometimes, eating disorders such as anorexia and bulimia also can play a role.
  • Foot problems. People who have flat feet or high, rigid arches are more likely to get stress fractures. Worn footwear often contributes to the problem.
  • Weakened bones. Conditions such as osteoporosis can weaken bones and make it easier for stress fractures to happen.
  • Past stress fractures. Having had one or more stress fractures puts you at higher risk of having more.
  • Lack of nutrients. Eating disorders and lack of vitamin D and calcium can make bones more likely to develop stress fractures.

Complications

Some stress fractures don't heal properly. That can cause long-term problems. It's important to not restart the activity that caused the stress fracture too soon. Doing so could put you at higher risk of larger stress fractures that may be harder to heal.

Prevention

Simple steps can help you prevent stress fractures.

  • Make changes slowly. Start any new exercise program slowly. Aim to make gradual progress over time. Don't build up the amount or intensity by more than 10% a week.
  • Use proper shoes. Make sure your shoes fit well and suit your activity. Think about getting new running shoes if yours are old or worn. If you have flat feet, ask your doctor about arch supports for your shoes.
  • Cross-train. Add low-impact activities to your exercise routine. These include biking and walking. They put less stress on bones than high-impact activities, such as running.
  • Get proper nutrition. Make sure your diet includes enough calcium, vitamin D and other nutrients. These help bones stay strong.

Diagnosis

To find out if you have a stress fracture, your doctor asks you about your health and does a physical exam. Often, imaging tests are needed too. They might include:

  • X-rays. Stress fractures often can't be seen on regular X-rays taken shortly after your pain starts. It can take weeks for signs of stress fractures to show on X-rays.
  • Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to make images of bones and soft tissues. This test is considered the best way to find stress fractures.
  • CT scan. This series of X-rays can make detailed images of the inside of the body. It can be useful when the results of an MRI aren't clear.
  • Bone scan. This exam isn't done often. Many types of bone problems look alike on bone scans, so the test isn't specific for stress fractures. It also uses a high dose of radiation. But a bone scan might be recommended if your doctor still thinks you have a stress fracture after an MRI finds no signs of the injury. With a bone scan, a small amount of radioactive material is given to you through a needle in a vein. The material is mainly absorbed by areas where bones are being repaired. These show up on the scan image as a bright white spot.

Treatment

Treatment aims to lessen the bone's weight-bearing load until it heals. You might need to wear a walking boot or brace or use crutches.

Sometimes, surgery is needed to help a stress fracture heal completely. You may be more likely to need surgery for stress fractures that happen in areas with a poor blood supply. Surgery also might be a treatment choice to help healing in elite athletes who want to return to their sport sooner. It may be an option for laborers whose work involves using the affected body part.

Let your doctor know if you have pain. You may be told to take small amounts of acetaminophen for relief. You'll likely be told to stay away from pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). NSAIDs can slow bone healing.

Self care

It's important to give the bone time to heal. This may take weeks or months. In the meantime:

  • Rest. Stay off the affected limb as directed by your doctor. Do so until you are cleared to bear weight.
  • Ice. This can ease swelling and pain. Place ice packs on the injured area for 15 minutes every three hours.
  • Get active slowly. When your doctor says it's OK, you can start doing activities that are gentle on bones, such as swimming. Then slowly take on your usual activities. Get back to running or other high-impact activities over time. Build up the time and distance bit by bit. Stop any activity that causes pain at the site of the stress fracture. Replace it with an activity that puts less stress on the bone until the pain goes away.

Preparing for your appointment

You're likely to start by seeing your primary doctor. If you are a competitive athlete, you might go straight to a doctor who treats muscle and bone problems.

What you can do

Before the appointment, make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including your level and type of physical activity, and whether you've recently been training more.
  • All medicines, vitamins or other supplements you take. Include the amounts you take, also called doses.
  • Questions to ask your doctor.

Take a family member or friend along if you can. The person could help you remember the information you're given.

For stress fractures, basic questions to ask your doctor include:

  • What is the likely cause of my symptoms?
  • What tests do I need?
  • Do I need to stop my activity? For how long?
  • Should I see a specialist?

Feel free to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions such as:

  • When did your symptoms begin?
  • Have you recently increased your physical activity?
  • Have you broken bones in the past?
  • Do you have regular menstrual periods?
  • Do you have any dietary restrictions?
  • Do you take vitamin D and calcium supplements?

© 2025 Mayo Foundation for Medical Education and Research. All rights reserved. Terms of Use