The injuries occur when the repetitive/ excessive strain placed on structurally normal bone, exceeds the process of remodeling (bone healing) resulting in stress fracture

Intrinsic factors include

• poor physical conditioning

• hormonal disorder/menstrual disorder

• poor bone density

• reduced muscle mass

• lower extremity deformity ex genu valgum knees, and a short leg.

Extrinsic factors include:

• high-impact sports activities like running, jumping

• abrupt increase in physical activity,

• irregular or angled running surface

• poor footwear/running shoe wear older than 6 months

• deficient vitamin D and calcium,

• smoking

The most common risk factor is an abrupt increase in activity.

Symptoms may begin as a mild ache or stiffness in the back of the leg or above the heel after activity. Overtime this pain may increase and occur during/after running, jumping, stair climbing or sprinting.

Stress fractures range in severity: high and low-risk fractures. This is depends on patient presentation and anatomic location of the injury.

General principles of management include relative rest/non-weight bearing for a period of 2 to 6 weeks, and then gradual reintroduction of activity.  

Conservative Treatment

• “RICE” Rest, Ice, Compression, Elevation

• Reduction of activity levels.

• Oral medications

• Shoe gear changes/Orthotic/Supportive devices

• Immobilization

• Physical therapy

• Pain lasers

Surgical therapy is reserved for patients who fail conservative therapy, or non-healing/chronic stress fractures.