Understanding Lower Leg Stress Fractures

A stress fracture is caused by micro-cracks in the bone that result from overuse and “fatigue failure of bone.”

Every day, the body produces new bone to replace the bone that is broken down by daily wear and tear. This is typically a balanced process, but increased stress from physical training and repetitive overuse can lead to micro-fractures, also known as stress fractures. If not addressed early, these smaller stress fractures can lead to full fractures.

Certain sports are more commonly associated with stress fractures: basketball, running, fitness class, racket sports, dance, and gymnastics. And, the most common lower leg stress fractures are tibia, tarsals, metatarsals and fibula.

Female athletes have 3.5 times the fracture risk of males, especially female runners and gymnasts. This higher risk may be related to underlying menstrual irregularities and decreases in bone density or factors specific to the female anatomy and biochemistry.

What A Stress Fracture Feels Like:

  • Pain is worse after activity and relieved with rest.
  • Short periods of rest may temporarily relieve the pain, but it starts to hurt as soon as you return to that activity.

How We Treat It:

  • Phase I: Pain control and rest, usually 10 to 14 days.
  • Phase II: Reintroduction of activity; may last several weeks depending on location and type of stress fracture.
  • Phase III: Preparation for return to competition. Increase sport-specific conditioning such as running drills, cutting drills, and selected skill work.
  • Treatment lasts until the patient is symptom free, which can take several weeks. Even once you’re no longer in pain you may not heal for 3 to 6 months.
  • Surgery is rarely necessary.


  • Correct training errors, such as forming and minimizing training frequency, duration and intensity.
  • Take adequate rest periods during training. Stress fractures are increased in first two weeks after increased training intensity.
  • Maintain a healthy diet/weight. Stress fractures are associated with lower fat intake, lower caloric intake, eating disorders, and weights less than 75 percent of ideal body weight.

Remember, your doctor can be your partner in developing an exercise routine and diet to fit your needs.

Dr. Semakula is a featured guest for our March docsTALK live show on Thursday, March 19th. Register today for this free event. Find out more tips and events for Living Well With Joint Pain by visiting www.LivingHealthierTogether.com.
By Barbara Semakula, MD, specialist in sports medicine and non-operative care of fractures, osteoarthritis and joint pain at Anne Arundel Medical Center’s Pasadena Pavilion. To reach Dr. Semakula, call 410-280-4707.

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