Stress fractures are one of the most common running injuries I treat as an orthopedic surgeon, and they’re also one of the most ignored.
As a lifelong athlete myself, I understand why. That nagging shin pain doesn’t feel serious at first. You tell yourself it’s just soreness, that you can train through it, that it’ll go away on its own.
It won’t.
I’ve been that athlete icing something “just in case” while planning tomorrow’s workout anyway. Now, from the other side of the exam table, I can predict what runners are thinking before they say it: “It’s probably nothing.” “I’ll take it easy this week.” “I can’t miss this race.”
Here’s what I’ve learned: stress fractures don’t care about your training plan. The pain that seems manageable today becomes the injury that sidelines you for months tomorrow.
Let’s talk about what they are, why they happen, and how we can get you back on your feet.
What Is a stress fracture?
A stress fracture, often called a hairline fracture, is a tiny crack in the bone caused by repetitivestress rather than a single traumatic event. Unlike a broken bone from a fall, stress fractures develop gradually. They’re part of a group of injuries we call overuse injuries, which also includes tendinitis and bursitis.
Think of your bones like a highway that needs constant maintenance. When you run, you’re creating tiny cracks from repetitive impact. Normally your bones adapt by repairing and strengthening themselves overnight. But if the damage outpaces your body’s ability to heal, the bone begins to break down faster than it can rebuild leading to a stress fracture. For athletes, this often happens during intense training cycles or when ramping up mileage too quickly.
Risk factors for stress fractures
- Intrinsic Factors: Low bone density, muscle weakness, abnormal alignment, hormonal imbalances, nutritional deficiencies.
- Extrinsic Factors: Training errors, hard or uneven surfaces, worn-out footwear.
Ignoring these risk factors can turn a minor issue into a major setback.
What are the common symptoms of a stress fracture?
Most stress fractures occur in the lower extremities — tibia, femur, and foot bones. Symptoms start as a dull ache after long runs or workouts and disappear with rest. If you keep training, the pain comes earlier, lasts longer, and eventually interferes with daily activities, even at night.
Types of stress fractures
Not all stress fractures heal the same way. Low-risk fractures (most shin and foot bones) heal with rest in 6 to 8 weeks. High-risk fractures are different.
- Low-Risk: Heal with rest and activity modification (4–8 weeks).
- High-Risk: Slower to heal, often requiring non-weight-bearing or surgery.
The key difference lies in healing potential and complication risk, with high-risk sites requiring closer medical attention.
High-Risk Locations :
- Femoral Neck (hip/groin pain)
- Anterior Tibia (“black line” on X-ray)
- Navicular (midfoot)
- 5th Metatarsal (outer foot)
How are stress fractures diagnosed and treated?
Stress fractures often don’t show up on initial X-rays. That’s when we order an MRI or CT, which catches what X-rays miss. Early diagnosis is everything.
A common question athletes ask is, how long does a stress fracture take to heal? Most low-risk stress fractures heal in 6 to 8 weeks with proper rest and activity modification, while high-risk fractures may take longer and sometimes require surgical treatment.
For most stress fractures, treatment doesn’t require surgery. It includes:
- Activity Modification: Avoid high-impact exercise for 4–8 weeks.
- Immobilization: Boots or casts for certain fractures.
For high-risk fractures, we sometimes need weeks of non-weight-bearing or surgery. As an orthopedic surgeon, I handle most of these injuries. However, for complex foot fractures such asthe navicular, I collaborate with my colleague, a foot and ankle specialist at NGPG. These cases may require highly specialized techniques.
How can you prevent stress fractures?
- Gradual training progression: gradually increase your training volume by 10% each week.
- Proper footwear: wear shoes with adequate cushion and support. Over time, that cushion and support will wear away, so we recommend replacing your shoes every 300 – 500 miles.
- Balanced nutrition: your body needs fuel to heal. Calcium, vitamin D, and adequate calories are essential for bone health.
- Cross train: mix running with strength training. Strong hips protect your bones.
- Listen to your body: pain that’s getting worse, not better, is your bone waving a red flag.
As someone who’s pushed through injuries, I know how hard it is to hit pause. But that short break can save your entire season.
When should you see a doctor for a stress fracture?
Don’t wait until you can’t walk. See an orthopedic surgeon if you have:
- Localized bone pain lasting more than a week
- Pain that worsens with activity
- Pinpoint tenderness on a bone
- Pain interfering with daily activities
Early intervention makes all the difference.
Ready to address the pain?
If you’re experiencing persistent pain or suspect a stress fracture, schedule an appointment online with NGPG Orthopedic Surgery & Sports Medicine. We’ll help you recover safely and return stronger than ever.
No time for an appointment? No problem.
NGPG Orthopedic Walk-In Clinics are open 5 days a week at four locations and our Black and Blue Orthopedic and Sports Medicine Walk-In Clinic on Monday mornings at nine different locations.
Bottom line, there is no reason to ignore the pain. Visit NGPG Orthopedic Surgery and Sports Medicine for more information.