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Stress fractures

Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of a bone that's been weakened by a condition such as osteoporosis.

Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you're starting a new exercise program, for example, you may be at risk if you do too much too soon.

Symptoms Causes Risk factors Complications Prevention

At first, the pain associated with a stress fracture may be barely noticeable, but it tends to worsen with time. The tenderness usually originates from a specific spot and decreases during rest. You also might experience some swelling around the painful area.

When to see a doctor

Contact your doctor if your pain becomes severe or persists even at rest.

Stress fractures are caused by the repetitive application of a greater amount of force than the bones of your feet and lower legs normally bear. This force causes an imbalance between the resorption and growth of bone, both of which go on all the time. Repetitive force promotes the turnover of bone cells, but you add new bone cells when you're at rest.

If your bones are subjected to unaccustomed force without enough time for recovery, you'll resorb bone cells faster than you can replace them. As a result, you develop "bone fatigue." Continued, repetitive force causes tiny cracks in fatigued bones. These cracks progress to become stress fractures.

Factors that may increase your risk of stress fractures include:

  • Certain sports. Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, or gymnastics.
  • Increased activity. Stress fractures often occur in people who suddenly shift from a sedentary lifestyle to an active training regimen — such as a military recruit subjected to intense marching exercises or an athlete who rapidly increases the intensity, duration or frequency of training sessions.
  • Sex. Women who have abnormal or absent menstrual periods are at higher risk of developing stress fractures.
  • Foot problems. People who have flat feet or high, rigid arches are more likely to develop stress fractures.
  • Weakened bones. Conditions such as osteoporosis can weaken your bones and make it easier for stress fractures to occur.

Some stress fractures don't heal properly. This may lead to chronic pain. If underlying causes are not addressed, you may be at higher risk of additional stress fractures.

Simple steps can help you prevent stress fractures.

  • Make changes slowly. Start any new exercise program slowly and progress gradually.
  • Use proper footwear. Make sure your shoes fit well and are appropriate for your activity. If you have flat feet, ask your doctor about arch supports for your shoes.
  • Cross-train. Add low-impact activities to your exercise regimen to avoid repetitively stressing a particular part of your body.
  • Get proper nutrition. To keep your bones strong, make sure your diet includes plenty of calcium and other nutrients.
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