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Stress Fracture

David A. Ross, MD, CAQSM and Nicole A. Ross, DO Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Overuse injuries caused by cumulative microdamage from repetitive bone loading

  • Stress fractures occur in different situations:

    • Fatigue fracture: abnormal stress applied to normal bon...

DIAGNOSIS

HISTORY

  • Insidious onset of vague bony pain over period of weeks. Pain is typically worse with physical activity.

  • Rest initially relieves pain.

  • If untreated, pain progresses and may occur earlie...

TREATMENT

  • Grade I to Grade II, and low-risk stress fractures are generally treated nonoperatively, including non–weight bearing and immobilization (4).

  • Grade III to Grade V, and high-risk stress fractu...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

  • Once the patient is pain free, low-impact training can start and be advanced gently as tolerated.

  • Once running has resumed, increase mileage slowly; no more than 1...

REFERENCES

1
Wright AA, Taylor JB, Ford KR, et al. Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med.  2015;49(23):1...

ADDITIONAL READING

Behrens SB, Deren ME, Matson A, et al. Stress fractures of the pelvis and legs in athletes: a review. Sports Health.  2013;5(2):165–174. [View Abstract on OvidMedline] 

SEE ALSO

Algorithm: Foot Pain 

CODES

ICD10

  • M84.38XA Stress fracture, other site, initial encounter for fracture

  • M84.369A Stress fracture, unsp tibia and fibula, init for fx

  • M84.376A Stress fracture, unspecified foot, init encntr for f...

CLINICAL PEARLS

  • The diagnosis of stress fractures requires a high index of suspicion. X-rays are often negative initially.

  • Identify and treat female athletic triad to prevent stress fractures.

  • To help p...

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