What Causes Stress Fractures and How You Can Avoid Them

by Karli Richards, DPM, Lexington Podiatry

Stress fractures are a common injury among athletes, fitness enthusiasts, and even individuals who suddenly increase their physical activity levels. Despite their small size, these tiny cracks in the bone can cause significant pain and require weeks, if not months, to heal. 

What Is a Stress Fracture?
A stress fracture is a small crack commonly occurring in weight-bearing bones such as the feet and legs. Unlike acute fractures caused by sudden trauma, stress fractures develop gradually over time due to repetitive stress or overuse.

The repetitive forces placed on bones during physical activity exceed the body’s ability to repair and strengthen them. As a result, small micro-cracks accumulate and can develop into a stress fracture.

Common Causes of Stress Fractures
Stress fractures often occur when individuals increase the intensity, frequency, or duration of physical activity too quickly. The most common causes include:

• Overuse or Repetitive Activity: High-impact sports such as running, basketball, or soccer can significantly strain bones.
• Sudden Increase in Physical Activity: Jumping into intense workouts without proper conditioning can overwhelm the body.
• Improper Footwear: Wearing shoes that lack support or cushioning increases the risk of injury.
• Bone Health Conditions: Conditions like osteoporosis or vitamin D deficiency can weaken bones, making them more susceptible to stress fractures.
• Poor Biomechanics: Flat feet, improper running form, or muscle imbalances can increase pressure on certain bones.
• Dietary Deficiencies: Lack of calcium, vitamin D, or proper nutrition can compromise bone density and healing capacity.
• Menstrual irregularity: Fluctuating or low estrogen levels can significantly weaken bone density, making them more susceptible to fractures from repetitive stress during physical activity.

Symptoms of a Stress Fracture
Stress fractures often develop gradually, making them tricky to identify in their early stages. Common symptoms include:

• Pain That Worsens with Activity: Pain typically begins during exercise and subsides with rest but worsens over time.
• Swelling and Tenderness: The affected area may feel tender to the touch and appear swollen.
• Localized Pain: Pain can be pinpointed to a specific spot on the bone.
• Bruising: In some cases, bruising may occur near the fracture site.

Ignoring these symptoms can make stress fractures worse, causing prolonged recovery times or more severe fractures.

Diagnosing Stress Fractures
If you suspect a stress fracture, it’s important to consult a healthcare provider. Diagnosis typically involves a physical exam to check for tenderness and swelling and imaging tests, including an X-ray, MRI or bone scan.

Treatment Options for Stress Fractures
The primary treatment for stress fractures is rest to allow the bone to heal. Specific strategies include:

• Rest and Activity Modification: Avoid weight-bearing activities for 6-8 weeks or as recommended.
• Immobilization: Some patients may need a boot, brace, or crutches to reduce pressure on the bone.
• Pain Management: Over-the-counter medications such as acetaminophen can help alleviate pain. Avoid anti-inflammatory drugs (NSAIDs) unless prescribed, as they may interfere with bone healing.
• Gradual Return to Activity: Work with a physical therapist or coach to ease back into activity and avoid reinjury.
• Nutrition Support: Ensure adequate calcium, vitamin D, and protein intake to promote bone healing.

Preventing Stress Fractures
Prevention is key when it comes to stress fractures. Here are some tips to keep your bones healthy and reduce your risk:

• Gradual Progression: Increase your workout intensity, duration, or frequency by no more than 10% per week.
• Proper Footwear: Invest in supportive shoes that match your activity and foot type.
• Strength Training: Strengthen muscles around your bones to absorb impact and reduce bone strain.
• Bone Health Nutrition: Include calcium-rich foods (e.g., dairy, leafy greens) and vitamin D sources (e.g., sunlight, fortified foods) in your diet.
• Maintain a healthy weight: Avoid excessive weight loss.
• Monitor menstrual irregularities: Monitor female athletes for menstrual irregularity or amenorrhea

Listen to your body, and don’t ignore persistent pain. Stress fractures may be minor, but they are a clear signal from your body that it needs rest, recovery, and proper care. Whether you’re an athlete, a runner, or just starting a fitness journey, understanding the causes and taking preventive measures can keep your bones strong and healthy.


Karli Richards, DPM, Lexington Podiatry