The Center for Podiatric Care and Sports Medicine

Are Stress Fractures Preventable?

Posted by on Wednesday, September 3rd, 2014


Dr. Josef Geldwert is a foot and ankle surgeon at The Center for Podiatric Care & Sports Medicine. Currently, he is working as the Chief Medical Officer of the NY Lizards lacrosse team, assessing their health during the preseason. This time of year, he sees child and teenage athletes, as well as professionals, who come in with overuse injuries like stress fractures. In today’s post, we explore the question: Are these hairline cracks in the bones inevitable due to the repetitive nature of sports-playing, or are there ways to prevent this type of injury?


stress fracture
It can be difficult to spot a stress fracture in an x-ray. Image Source:

Who is at risk?

Most commonly, we see stress fractures in sports that involve a lot of running — basketball, track, cross-country, football, and tennis. We also see a lot of gymnasts and swimmers injure themselves from overtraining. Runners need to be particularly mindful not to increase their mileage or activity level too quickly. Kids — under the age of 15 (girls) to 18 (boys) — are at risk for growth plate injuries, since this part of the bone is less fixed and weaker. Conversely, older adults with osteoporosis have an increased incidence of stress fractures as well. If your feet have particularly high arches or are especially flat, you are more likely to develop stress fractures in the feet, ankles, and legs.

A 1999 study published in the Journal of Sports Medicine found that the most prominent predictors of stress fracture included:

– Low or no menstrual flow (in women)

– Caloric restriction

– Lower bone density

– Muscle weakness, and

– Leg length differences.

Do you have a lower limb stress fracture?

Unlike traumatic fractures, you can probably still walk on a stress fracture. The pain tends to build progressively over time, rather than suddenly hurting tremendously out-of-the-blue one day. “The pain is a very localized pain deep within the foot, leg, or ankle,” says Dr. Geldwert. “It can become a nagging ache like a pulled muscle that grows to an unbearable discomfort eventually that disrupts even the most basic activities like walking.”

According to the American College of Foot & Ankle Orthopedics & Medicine, popular myths about stress fractures include:

– You will suffer limited ability to wiggle your toes and be unable to walk.

– You will always see bruising and swelling when there is a bone fracture.

– You will see a crack on an x-ray.

Often, the only way to truly tell if a person has a stress fracture is to see a foot and ankle specialist who can give them a physical exam and assess the results of an MRI or CAT scan. Once the healing process has begun, the new bone growth will be seen as a thin white line.

How are stress fractures treated?

The first step to recovering from a stress fracture is to stop the activity that caused the problem. For competitive athletes, we may simply tailor their training to running in the pool or swimming to maintain cardiovascular stamina in the meantime. Some patients will have to wear a walking boot or cast to keep the weight off while healing. It could take anywhere from six weeks to several months to heal. Physical therapy is often prescribed to strengthen the surrounding support structures.

Can stress fractures be prevented?

Dr. Geldwert says, “We always caution young athletes to begin their preseason training well before the school’s ‘preseason.’ You will want to allow yourself enough time to gradually build to a competitive level. This is especially true for anyone participating in fall sports, where kids have usually taken the summer off.”

Athletes should work closely with a sports medicine doctor to see that their training programs are not too rigorous. They should also participate in cross-training activities that build flexibility, strength, and skill. Swimming and bike riding are good ways to give your body a “break.” Be sure you are getting adequate protein, carbs, fats, calories, and essential nutrients like Vitamin D and calcium. Avoid these “bone robbing” foods.

Much of the recent research is focuses on preventative measures for competitive athletes. Often, biomechanical factors are at play. For instance, you may have tight calf muscles, weak toes, or an inadequate piriformis muscle. Strength-training exercises and simple changes to stride or form can go a long way in preventing repetitive stress injuries.

If you live in the NYC area, contact Dr. Geldwert to address your concerns about stress fracture injuries.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.