About stress fractures
Bone constantly remodels in response to load. When training increases faster than bone can adapt, or when the body lacks the energy and nutrients to rebuild, small areas of bone can weaken and crack. This ranges from a stress reaction, an early stage, to a true fracture line.
Stress fractures are common in runners, dancers, military recruits, and athletes in jumping sports. They are especially important in female athletes, where they may be linked to low energy availability, menstrual changes, and bone density loss, a pattern known as relative energy deficiency in sport.
Some stress fractures heal well with a period of modified activity. Others occur in high-risk locations with a poorer blood supply, where healing is slower and a full break is more likely, so these need closer care.
Common symptoms
- Pain that builds during activity and becomes more constant over time
- Pinpoint tenderness over a specific spot on the bone
- Swelling over the painful area, often on the top of the foot or along the shin
- Pain with hopping on the affected leg
- Pain at rest or at night as the injury progresses
Common causes and risk factors
- Rapid increases in running mileage, intensity, or impact
- Low energy availability from not eating enough to match training
- Low bone density, low vitamin D, or menstrual irregularities
- Changes in footwear, surface, or foot mechanics
- A previous stress fracture
How we diagnose it
Dr. Chen takes a detailed history of training, nutrition, and, when relevant, menstrual health, and examines the painful area. Diagnostic ultrasound at the exam table can show early signs such as swelling of the bone lining, and it helps rule out tendon problems. X-rays often look normal early on, so MRI is used to confirm the diagnosis and grade the injury, and bone health testing may be recommended.
How Propel treats stress fractures
Treatment is matched to the bone involved and how advanced the injury is. Many stress fractures heal with a period of reduced impact, sometimes with a walking boot, while you keep fitness through cycling, swimming, or strength training. High-risk fractures may need stricter offloading and, in some cases, a surgical opinion, which we help coordinate.
Dr. Chen builds a gradual return-to-running plan and addresses the reasons the bone was overloaded: training load, fueling, vitamin D and calcium, sleep, and bone density. Progressive strength training for the legs and hips is part of the plan, since stronger muscles help protect bone.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about stress fractures
- Why do stress fractures often not show on X-rays?
- Early stress injuries may not show on X-rays for several weeks, until the bone begins to heal. MRI can detect a stress reaction or fracture much earlier, which helps guide treatment.
- What is relative energy deficiency in sport?
- Relative energy deficiency in sport happens when an athlete does not take in enough energy to support both training and normal body functions. It can affect bone health, hormones, and menstrual cycles and raises the risk of stress fractures in athletes of any sex.
- Can I keep exercising with a stress fracture?
- Usually you can stay active with low-impact exercise, such as cycling, swimming, or upper-body and core strength work, while the bone heals. We guide which activities are safe for your specific injury.