Stress Fractures In Runners: Causes, Symptoms, Tests & Treatment

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Cross Training For Runners
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David Dack

Out of all running injuries, nothing strikes more fear into a runner’s heart than stress fractures. They’re a painful, nagging condition that requires long weeks, even months, of recovery.

What’s more?

This notorious injury is common among runners, especially those that run long distances and/or push themselves more than they should.

So would you like to learn more about how to manage stress injuries in runners? Then you’ve come to the right place.

In this post, I’ll provide a full overview of stress fractures in runners. By the end, you’ll learn the following:

  • What is a stress fracture?
  • The causes of stress fractures in runners
  • The most stress fracture-prone areas in runners
  • The main symptoms to look for
  • Can you run with a stress fracture?
  • And so much more

Stress Fractures In Runners Explained

Also known as a hairline fracture, basically a small crack or severe bruising in a bone.

Stress fractures are the classic form of overuse injury caused by the gradual build-up of trauma from repetitive submaximal loading and bad posture.

The typical stress fracture onsets as a stress reaction, which manifests as swelling around the bone.

Then, in case it progresses, it can develop a small crack. If this injury reaches this stage,  you’ll likely have to rest the injured limb for a few weeks—even months—to let your body heal.

Surveys show that stress fractures may account for 20 percent of all running injuries.

Athletes who participate in high-impact sports like basketball, football, and soccer are also prone to this condition.

In some cases, but rarely among productive age runners, stress fractures may be blamed on inadequate bone mineral density or bone diseases, such as osteoporosis.

They can also be traced to genetic disorders or nutritional and hormonal imbalances.

Stress Fractures Vs. Bone Breaks

This may surprise you, but a fractured bone and a broken one aren’t technically the same.

As I explained earlier, a stress fracture is a bone crack or break that occurs when force is applied to a bone repeatedly and over time.

This means that they develop slowly over an extended period.

The other characteristic is your bone stays still in the same place. You won’t even notice anything except the ongoing pain or bruising.

On the other hand, the typical bone break happens when an outside force is applied suddenly to a bone. The key here is the discontinuation of bone structure.

Falls, car accidents, and sports contacts like football can often cause bone breaks.

Common Stress Fractures In Runners

A stress fracture can strike any bone, but the weight-bearing bones are most prone in runners.

Let me explain.

The lower leg in the shin bone (the tibia) is the most affected area.

Survey shows that about half of all stress fractures occur in the tibia.

But stress fractures are also common in other bones.

The foot, especially the second metatarsal, is another stress fracture-prone bone.

More specifically, the second and third metatarsals in the foot, according to the American Academy Of Orthopedic Surgeons. According to surveys, roughly 25 percent of all stress fractures strike these two bones.

The condition is also pretty common in:

  • The heel, what’s known as the calcaneus;
  • The ankle joint, more commonly in a small bone called the talus;
  • The fibula, the outer bone of the ankle and lower leg; and
  • The navicular is a boat-shaped bone on the top of the midfoot, specifically in the ankle between the talus and the cuneiform bones.
  • The talus is a small bone located within the ankle joint

Extreme (but rare) Cases of Stress Fractures

The bigger bones in your pelvis, hips, and femur are also prone to stress fractures, which aren’t common among runners.

And only a few people can feel it since it’s not the main weight-bearing.

Causes of Stress Fractures While Running

The primary cause of the condition is, of course, overuse.

If you increase your training volume and/or intensity too fast and over a short period, you’re setting yourself up for injury.

Other factors that may contribute to stress fractures include:

  • Bad footwear. Running in improper running shoes that provide little or no shock-absorbing ability.
  • Being a female runner. Research shows that female athletes are more prone than male athletes. This is blamed on the so-called “female athlete triad,” a mix of eating disorders, bone density issues, and menstrual dysfunction.
  • Running technique. Overstriding may sometimes contribute to tibial stress fracture as it stresses the main weight-bearing bones more.
  • Inadequate nutrition. For example, insufficient vitamin D intake can put you at risk, according to research from The Journal of Foot & Ankle Surgery.
  • Bone conditions. Bone disease compromises bone strength and density. Osteoporosis is one example.
  • Weather condition. Research shows that stress fractures are more common in the winter than in any other season of the year due to a deficiency in Vitamin D.
  • Foot Abnormalities. According to research, runners with anatomical foot abnormalities, such as fallen arches, are more prone to stress fractures than those with a neutral arch.
  • Muscle tightness. Research from the Journal of Orthopedic and Sports Physical Therapy reported that tight calves make you roughly five times more likely to sustain a metatarsal stress fracture.

Symptoms of a Stress Fracture

If you notice any bony tenderness that worsens during running but subsides during rest, you might be experiencing the onset of a stress fracture.

Stress fractures are characterized as achy or generalized pain in and around the affected area.

You can’t pinpoint the exact place.

This pain usually develops slowly and worsens during running or any weight-bearing activity.

Pain worsens the more miles you log in. Then, it becomes highly localized to a specific “area” on the bone, which will even be painful to the touch. Sometimes it causes bruising but is mild.

Devoid of rest, the pain gradually worsens—to the point where it limits your range of motion and alters your running gait.

stress fractures while running

How Are Stress Fractures Diagnosed

Sometimes, your doctor can diagnose a stress fracture from a medical history and physical checkup, but imaging tests are often required to confirm the condition.

Since stress fractures are thin, X-rays usually cannot spot them, especially shortly after the onset of pain. The doctor may recommend an MRI or CT scan in addition to the physical checkup.

Can you Run With a Stress Fracture?

Though you might feel tempted to run on a stress fracture, it’s never a good idea. Running through a stress fracture does nothing but delay healing and will likely cause a compensatory injury for changing your running gait.

From my experience and the stories I’ve heard, I wouldn’t risk it.

It’s the dumbest thing you can do as a runner.

Running through the tibia, fibula, or fracture requires a more serious injury. It’s also painful since these are the major weight-bearing bones that withstand a lot of the stresses of running.

What’s the next plan?


If it’s an incomplete fracture with no misalignment, bandage, and casting might help. But if it’s a complete fracture with multiple breakages, a knife and fixation are the only solution.

Next? Six months rest.

As a rule of thumb, avoid running through a stress fracture.

What Should I Do If I Do Have A Stress Fracture?

If you suspect a stress fracture, stop training altogether and do what you must to speed up recovery.

Next, visit a physician—preferably a podiatrist or an orthopedist—to have it diagnosed.

Let me break down what you need to do.

Stop High Impact Exercise

Your first step is to let the affected bone(s) recover completely following injury.

It takes at least 28 days for complete remodeling.

I’d recommend that you cross-train during your recovery period.

Choose exercises with minimum impact.

Ideal options include aqua jogging, cycling, swimming, or yoga.

You’re good to go if you avoid high-impact weight-bearing exercises like running, rope jumping, and plyometrics.

Keep it as long as you feel comfortable before adding the intensity.

Reassess every month.

Cold Therapy

Apply ice on the affected area to keep swelling down and ease tenderness.

I’d recommend using a frozen bag of beans or ice wrapped in a towel or cloth for 15 to 20 minutes at a time, at least three times a day.

Just whatever you do, do not apply a source of cold directly on your skin.

Compress it

Compress the injured limb by lightly wrapping it in a soft elastic bandage to reduce swelling.

Elevate it

Keep your injured limb raised higher than your chest level.

Using a hanging traction device can help.

Severe Cases

What should you do if home treatments don’t improve your symptoms?


Consult a doctor or podiatrist.

They will help you determine your injury’s exact location and severity and what to do next to bounce back and speed up your recovery.

Left untreated, stress fractures can result in the bone breaking completely.

Further Tests

First of all, expect to be X-rayed.

But you may need to do more.

Often, traditional X-rays may look healthy as they might not be enough to spot a stress fracture, especially when the fracture is not completely through the bone.

For this reason, I recommend you consult a sports-oriented physician for a thorough bone scan.

They’ll typically recommend a nuclear bone scan, an MRI, or other advanced imaging techniques to fully detect the condition.

The Doctors Recommended Treatment Options

Your doctor will recommend taking an NSAID—Nonsteroidal anti-inflammatory drugs— such as Ibuprofen and Paracetamol to alleviate pain and reduce swelling.

Depending on the area and the severity of the stress fracture, your doctor might also recommend a splint, a cast, or protective footwear  (such as a wooden-soled sandal or a stiff-soled shoe) to immobilize the injured limb.

Crutches are also recommended to keep weight off the injured leg until you’re past the acute phase.

Sometimes, your doctor may need to put a fracture boot on the injured limb to keep the bones fixed.

This helps eliminate the stress on the leg and speed up recovery.

Expect Surgery As The Worst-Case Scenario

In extreme stress fractures, surgical intervention is needed to patch up the damage, especially when the fracture line has extended completely across the bone, or you have low bone density.

This is done by inserting a type of fastening, known as internal fixation, to support the bones of the injured area. External fixation might be one of the treatment choices for osteoporotic patients.

Again, it depends on the severity and alignment.

How long It Takes To Recover From A Stress Fracture

Recovery time varies from one runner to the next.

The good news is that most stress fractures will heal after time and rest.

Some people can recover well, starting from 28 days, but most take six weeks to six months or even longer.

That’s a wide range.

And reason stress fractures are categorized into two main groups:low risk” and “high risk.”

A stress fracture within the low-risk category often heals independently and may not call for aggressive treatment measures such as long rest time or crutches. This category includes fibular and tibial stress fractures as well as metatarsal stress fractures.

On the other hand, a high-risk stress fracture often occurs in areas notorious for healing poorly. Examples include stress fractures of the pelvis, navicular, and femur. If you develop fractures in any of these bones, you’ll need drastically longer times away from running and a proactive approach to resuming running again.

The only good news is that these high-risk fractures are less common in runners than in the low-risk types.


Stress Fractures in Runners – The Conclusion

There you have it!

If you’re serious about learning to better manage stress fractures from running, then today’s post should get you started on the right foot.

The rest is just details.

Please feel free to leave your comments and questions in the section below.

In the meantime, thank you for dropping by.

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