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Stress Fractures


Updated June 12, 2014

Ankle injury. Female runner with an ankle injury.
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Stress fractures are tiny cracks in the surface of a bone, and most often occur in the lower leg or the foot. You'll notice gradual muscle soreness, stiffness, and a pinpoint pain on the affected bone. Early diagnosis is critical because the injury can spread and eventually become a complete fracture of the bone.


Stress fractures most frequently happen when runners increase the intensity and volume of their training over several weeks to a few months. A shortage of calcium or a biomechanical flaw -- either in your running style in or your body structure – may also contribute to the injury. Common stress fractures in runners occur in the tibia (the inner and larger bone of the leg below the knee), the femur (thigh bone) and in the sacrum (triangular bone at the base of the spine) and the metatarsal (toe) bones in the foot.


Make sure you're wearing the right shoes for your foot and running style. Get a gait analysis at a running shop. Replace your shoes every 300-400 miles. Don't increase your weekly mileage by more than 10% each week. Take days off from running and cross train to avoid putting too much stress on certain areas of your body. Eat a healthy, balanced diet and make sure you're getting enough calcium and vitamin D (necessary for calcium absorption). Talk to a doctor about whether you should be taking any supplements. Avoiding carbonated beverages, alcohol and tobacco helps to reduce the risk of low bone mineral density.
Strengthening the muscles around your bones can keep them strong enough to avoid stress fractures. Because the tibia (shin bone) is the most common site of stress fractures, make sure you're strengthening your shin muscles and calves doing simple exercises such as toe raises and heel raises.


If you have symptoms of a stress fracture, you should stop running immediately and see a doctor. He or she can perform an x-ray which may show a crack. However, stress fractures sometimes don't appear on an x-ray, so a bone scan may be necessary to diagnose it.
Your injury will likely keep you off the roads for about six weeks, and depending on the severity of the stress fracture you may need a cast. Don't mess around with a stress fracture -- it's not the type of injury that you can run through. It's serious and could get worse if you continue to keep running. Rest, anti-inflammatories, stretching, and muscle strengthening are recommended treatments. Cross-training and water-running are possible alternatives to running while you're recovering. Make sure you eat a nutritious diet, since improper nutrition, especially a lack of calcium, may slow healing.
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