Stress Fractures in the Lower Extremities

Let’s talk stress fractures—specifically in the lower extremities. 


I feel like I’ve been finding a TON of these lately so let’s cover what they are, how to best treat, and other considerations. 

Common areas that I find stress fractures the most are the lower leg (tibia or fibula bone) and in the foot (metatarsal bones or navicular bone). 


What is a stress fracture?

  • A stress fracture is a small break or “crack” in the bone.


What causes a stress fracture?

Lots of factors can contribute to a stress fracture.  Most common activities for stress fractures in the lower extremities comes from running, jumping and repetitive stress activities. 

                        Other considerations:

  • Rapid increases in exercise programs
  • Female
  • Hormonal and menstrual imbalances
  • Low bone mineral density
  • Nutritional deficiencies
  • Running on irregular and angled surfaces
  • Poor flexibility
  • Inappropriate footwear
  • Muscular strength imbalances


How do you diagnose?

  • A thorough exam is the most helpful at determining stress fx diagnosis. Radiographs are sometimes helpful, but do not always depict clearly the stress fracture.  MRI’s would be a gold standard for diagnosis. 
    • Pin point tenderness over the bone is usually a good indicator too.


What are my treatment options?

  • Conservative care is recommended for several weeks (generally 6-8 weeks) until the site is pain free.
    • This may include utilization of bracing, casting, or a boot.
  • Activity modification is crucial! However, for active patients, it is important to modify and replace activity for recommendation compliance.  If you’re like me, telling me not to do something only makes me want to do it more.  So let’s work together to replace activity that would aggravate with movements that will allow healing. 
  • Surgery is very rarely clinically indicated.


How can I prevent this from happening to me?

  • If you plan on starting a new exercise plan, gradually increasing your intensity is important. This is why we often see stress fractures in seasonal runners (think cross country athletes or track athletes that do not regularly train in the off season), military recruits, etc.
  • Quality warm-up prior to physical activity.
  • Running with footwear in good condition and on smooth surfaces.


I’ve had a stress fracture in my tibia that went misdiagnosed for nearly 6 months.  The pain also started during track season (hmmmmm….).  After appropriate diagnosis and treatment, they will heal.  It is also important to work with a skilled provider to identify how this happened, what you can do to remedy the problem and prevent this from happening again.