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Why are Stress Fractures Common in Athletes?

Stress fractures are an overuse injury that presents with small or tiny cracks in a bone. They tend to be more common in the lower limb than the upper limb because of the stress on the lower body. The bones of the foot, ankle and lower leg are most at risk to repetitive forces and stress absorbed during activities. Stress fractures begin when the muscles are fatigued and are unable to absorb the forces of the activity, thereby more force is transferred to the bone. Repetitive stress will cause damage that does not have time to heal, with every subsequent activity causing more damage until bone fractures and pain results. Sometimes the pain does not manifest until a few minutes into the activity, allowing the athlete to feel that is ok to push through the pain, which may cause further damage and injury.

The most common sites of stress fracture in the lower limbs are the metatarsals, particularly the second and third metatarsals. Another common area of injury is the tibia, the main load bearing bone of the lower leg, as it absorbs most of the forces during weight bearing activities. Uncommonly, stress fracture of the femur can occur. It is a very serious injury. Stress fractures of the femur is usually seen in those athletes that have increasing levels of activity without proper nutrition.

Athletes who play sports which require repetitive running and jumping are vulnerable stress fractures. It is also one of the most common sports injuries in military recruits. In the military, stress fracture is also called march fracture. This is likely due to the sudden increased demands of new recruits combined with the poor support afforded by military boots.

The most common symptom of a stress fracture is pain. Pain develops gradually and there is no other obvious sign of injury to the athlete (some rare cases may present with tenderness or swelling). Therefore, athletes continue to perform their usual activities without knowing that they already have an injury.

Treatment for Stress Fractures

In most cases, treatment of stress fractures includes rest and avoiding weight bearing activities. In some patients bracing can be used as well. This form of treatment allows the bone to heal on its own and usually takes 6-8 weeks. For those who want to remain physically active during this period, training focused on the upper body should be substituted for lower body activities.

In rare cases, the bone may not heal on its own due to the severity of the injury or underlying biological factors and a bone stimulator can be tried to avoid surgery. If warranted, a surgical procedure is performed to place a pin through the bone to secure the fracture and allow it to heal.

The most important aspect to healing properly from a stress fracture is consulting an orthopedic specialist at the first sign of injury so treatment can start immediately and further damage can be avoided.


At The Orthopaedic & Sports Medicine (OSM) Center we utilize the collective skills of our exceptional providers to deliver the most complete musculoskeletal care available. From your first appointment, you are cared for by a team specifically built based on the best treatment for your condition. If surgery is necessary, you will be paired with an OSM surgeon who has the expertise and experience in your specific condition. Our surgeons use the latest minimally invasive techniques where appropriate to ensure fast recovery.  Contact us today to schedule a consult.