Stress Fracture

Bone and Joint Conditions· Also known as: fatigue fracture, hairline fractureUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

A stress fracture is a small crack or break in a bone. It happens when the bone is loaded again and again, often after a sudden rise in activity, and can't repair itself in between. It is mostly seen in athletes and military recruits, and most often in the lower leg and foot. The main symptom is pain in one spot that builds with impact activity and eases with rest. Many stress fractures heal well with the right care, but some sites need closer attention, so get it checked.

What is it?

A stress fracture is a small crack or break in a bone. It isn't caused by one big injury. It comes from repeated loading that is too small to break a healthy bone in one go, but adds up over time.

Your bones constantly repair themselves. A stress fracture develops when the forces on a bone get ahead of that repair work. It sits at the more serious end of a range of bone stress injuries, which run from early stress reactions (a bone under strain) to an established crack.

Who does it affect?

Stress fractures are mostly seen in athletes, especially endurance athletes and people in pre-season training, and in military recruits. In army basic and special training, up to about 7 per cent of men and 21 per cent of women are affected. It isn't clear how common they are in the general public or in children.

Most stress fractures are in the lower limb. The shin bone is the most common site, and the foot is the part of the body most often affected. The long bone on the outer edge of the foot (the fifth metatarsal) is another common site, especially in athletes.

Signs and symptoms

The main symptom is pain in one spot on a bone. It usually comes on gradually over a few weeks. It gets worse with impact activity such as running or jumping, and eases with rest.

At first the pain may only come on during activity. If you keep going, it often starts to hurt after activity as well, and eventually even at rest. Night pain can also happen.

You may see little or no bruising or swelling. Some people do have swelling or warmth over the sore spot.

What causes it?

The most common trigger is doing too much, too soon. A sudden jump in how much, how hard or how often you train is one of the strongest and most consistent risk factors. A new job, gym class or running program can do the same.

Several other things raise the risk. Some are about your body, such as bone strength, vitamin D levels, muscle strength, fitness, nutrition, sex and age. Some are about your load, such as training habits and footwear. People who have had a stress fracture before are more likely to have another.

Foot shape can play a part. Runners whose heel tilts outwards (especially with a lot of rolling in of the foot) and athletes with a very high arch have up to 40 per cent higher risk.

Female athletes with missed or irregular periods, low body weight or disordered eating are at higher risk of bone stress injury. People whose bones are weakened by a condition such as osteoporosis can also get a stress fracture from everyday activity.

How is it diagnosed?

Your story is the most important part. Your podiatrist will ask when the pain began, what you were doing before, whether it hurts during activity, at rest or at night, what makes it better or worse, and whether it disturbs your sleep. They will press on the sore spot and check how you move.

An X-ray is usually the first scan. But an X-ray often doesn't show a stress fracture until two to eight weeks after the pain starts, so an early X-ray can look normal even when there is a crack. Scans are used to confirm what your clinician finds, not to replace the examination.

Other things can cause pain in the leg with exercise. Medial tibial stress syndrome (often called shin splints) is one of the most common, affecting up to 20 per cent of runners and 35 per cent of military personnel. Chronic exertional compartment syndrome (pressure building in the muscles of the leg during exercise) can feel similar. They can be hard to tell apart, which is one reason to have the pain assessed.

Treatment

Treatment depends mostly on which bone is affected. Some sites are called low-risk and usually heal with simple care. Others are called high-risk because they heal poorly and are more likely to become a complete break or fail to knit together. Lists of high-risk sites vary a little, but commonly include the neck of the thigh bone, the sacrum (at the base of your spine) and pelvis, the heel bone, a bone on top of the arch (the navicular), the front of the shin bone and the fifth metatarsal. The ankle bone (talus) and small bones near the big toe joint are on some lists too.

Looking after it at home

For low-risk sites, the first step is to stop or cut back the activity that brings on the pain. Simple pain relief can be used if you need it. Depending on the site, you may also be told to take some load off the bone.

When the pain has settled, you return to activity gradually, over an extended period. Don't go back to any activity that brings your symptoms back. For a rib stress fracture, for example, this gradual return usually takes about 4 to 8 weeks once the pain has gone.

Treatment from your podiatrist

Your podiatrist can work out which bone is involved and whether it is a low-risk or high-risk site. That decides what comes next. It is worth asking them which one yours is.

For a stress fracture in the small bones near the big toe joint, care usually means changing your activity, pain relief, shoe inserts (orthotics) and physiotherapy for 2 to 6 months. Shin bone stress fractures are also treated without surgery first.

Some people are given a boot, crutches or a cast. It isn't clear yet which of these works best, and healing times vary by site, so follow the advice for your particular bone.

Other options

High-risk sites need a more thorough work-up and treatment. This often means a long period of keeping all weight off the leg, rather than the usual cutting back on activity. If you are advised to do this, it is important to stick with it.

Don't start medicines or other add-on treatments for a stress fracture without advice from a health professional.

Surgery

Most people with a low-risk stress fracture don't need surgery. It is considered for high-risk sites, for fractures that are at risk of getting worse, moving out of position or not healing, and for fractures that are still painful after a proper trial of care without surgery.

For the front of the shin bone, surgery is considered if it is still painful after 3 to 6 months of other care. For the small bones near the big toe joint, it is considered if symptoms continue after 2 to 6 months. Fractures at the base of the fifth metatarsal and in the navicular often need surgery for a good result. A stress fracture on the upper side of the neck of the thigh bone can have serious results if it isn't treated with surgery. Surgery has its own risks, so the decision is best made with a specialist, such as a sports medicine doctor or an orthopaedic surgeon.

Recovery

How you recover depends mostly on the site. Low-risk fractures such as ribs have a good outlook with the right care. High-risk sites are more likely to heal slowly or not at all, and may need more than rest.

The neck of the thigh bone is a good example. A delay in diagnosis is common, and it makes the bone more likely to move out of position. After a displaced fracture, return to sport is less likely (40 per cent) than after a fracture that hasn't moved (62 per cent). If surgery is needed for a displaced fracture, delay raises the risk of complications.

The best way to protect your recovery is to get it assessed early and not push through the pain.

Preventing it

Build up running, jumping or new work and gym activity gradually, and build in recovery time. Avoiding sudden jumps in how much, how hard or how often you train is a sensible way to lower your risk.

It isn't clear yet that special shoes or shoe inserts prevent stress fractures, so don't rely on them alone. Your clinician or coach can help you look at your training build-up and footwear.

If you are an athlete with irregular or missed periods, low body weight or restrictive eating, raise it with a health professional. These raise your risk of bone stress injury. Eating concerns often come with anxiety or low mood, so early, supportive help is worthwhile. If you are an athlete, ask your clinician about under-fuelling (not eating enough for the energy you use).

When to see a podiatrist

When to book

Book an appointment with your podiatrist if you have pain in one spot on a bone that has built up over a few weeks with running, jumping or other impact, or that gets worse if you keep going. Please don't run through it. See your GP or podiatrist soon if the pain wakes you at night or starts to hurt at rest. See your GP soon if you have pain that never lets up, a fever, weight loss you can't explain, or a lump. See your GP soon if hip symptoms haven't improved after 6 weeks, or if they are getting significantly worse. Children and teenagers with a possible stress fracture should be seen by a health professional.

When to get help sooner

This needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. Do this if it hurts to put weight on your leg, if you suddenly can't put weight on it, or if you have sudden severe hip pain, a sudden change in the length of your leg, or hip pain after a significant injury or a suspected broken bone or dislocation. Do the same if you get groin, hip or upper thigh pain when you exercise that eases with rest, because a crack in the neck of the thigh bone is one possible cause and it can get worse if it isn't found early.

Frequently asked questions

Can I keep running or exercising?

Stop or cut back the activity that brings on the pain until you've been assessed. Running through it can let a small crack get worse. Your podiatrist can tell you which activities are safe for your bone.

My X-ray was normal but the pain continues. What now?

Tell your clinician. Ask them to match any scan to what they find on examination, and whether a repeat scan is needed. In the meantime, keep off any activity that brings the pain on.

When can I go back to sport?

It depends on the bone affected and how it is healing. You return gradually, over an extended period, once your pain has settled. If your symptoms come back, stop and let your clinician know. Don't return to any activity that brings them back.