Where Does a Stress Fracture Occur?

23 December, 2019
A stress fracture typically occurs in the feet. However, it isn't easy to diagnose because the crack is so small it often doesn't show in the x-rays. Unfortunately, it often goes untreated and may give rise to intense and chronic pain.

A stress fracture happens when there’s a small break in a bone that originates in something other than a strong blow. Typically, it’s either triggered by repetitive movements or by a rapid increase in the amount or intensity of an activity.

These types of fractures aren’t easy to diagnose. Thus, they require a medical specialist and complementary tests to distinguish it from other conditions. This is because the fracture isn’t usually detected in an x-ray.

Athletes are most exposed to a stress fracture. In fact, 2% of sports injuries are this type of fracture. It’s quite painful and there is also a risk that the fractured parts of the bone could shift.

What is a stress fracture?

An X-ray of a fractured clavicle.
A stress fracture can occur as a result of the overload of physical activity.

When there’s no continuity in the bone tissue, it’s because there’s a fracture. Most of these injuries occur due to blows or trauma. However, in the case of a stress fracture, the cause of the problem is often just weakness or fatigue. There’s a weakness when there are bone deficiencies. On the other hand, there’s fatigue when there is continuous abuse of the muscles due to repetitive or extraneous activity.

A stress fracture is a kind of sliver or a crack in the bone. They happen due to repeated microtrauma or overload, as we said above. In addition, they may present a severe pain when performing certain physical activities. Then, they often disappear when the activities end.

You may not know it, but bones are made up of collagen. This is a compound that facilitates a bone remodeling process when subjected to aggression. It’s a way to reabsorb any damaged tissue and then reshape it. However, if the impact is continuous or too sudden due to overload, then the damage exceeds our body’s ability to replenish the collagen. This is just what happens when there’s a stress fracture, due to overload or repetitive movements or osteoporosis.

Read: Bone Pain: Causes, Symptoms and Treatment

Types of Stress Fractures

There are two groups of stress fractures: low risk and high risk. This classification is due to factors such as the affected area, the potential for complications, healing time, the presence of pseudoarthrosis, and the way in which the fracture healed.

The characteristics of each group are:

  • Low-risk fractures. These are treated simply with the elimination of the activity that generates the injury. Furthermore, they correspond to fractures in the upper extremities, rib, pelvis, femur, tibia, lumbar vertebrae, fibula and calcaneus.
  • High-risk fractures. This type of stress fracture has considerable potential for complications. This is because it often has to do with injuries in the femoral neck, the tibial malleolus, the tarsal scaphoid, the talus and the base of the metatarsal.

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Main Locations

A person adjusting their running shoes.
There are different fractures associated with each sports discipline, depending on the exercised muscle groups.

A stress fracture can affect a large number of bones in our body that, for one reason or another, are subject to repeated impact. However, feet are the points at the highest risk of a stress fracture.

The most common feet fractures are the following:

  • Fracture of the second metatarsal. This is the most frequent stress fracture because it’s connected to the longest toe, which is the one that most holds the load during athletic activities.
  • Fracture of the fifth metatarsal. This one is typical of all activities that require lateral displacements and jumps.
  • Calcaneal fracture. This tends to occur in activities in which the primary support lies in the heel.
  • Astragalus fracture. This isn’t too common and it isn’t specific to any particular activity or sport. However, it’s a great inconvenience when it does happen.
  • Fracture in the internal malleolus of the ankle. This is typical in activities that involve long-distance jumps and/or running races.

Likewise, it’s relatively common for a stress fracture to occur in other areas of the body. In particular, the happen in the fibula, the pelvis, the femoral neck, the sesamoids of the foot and the epiphysis of the fibula.

Final notes

There are stress fractures that are more typical of each discipline from the point of view of each sport. The metatarsal is more common in marathoners, foot players, dancers, and volleyball players. Similarly, the fracture of the first rib is more frequent in handball players. In addition, those that occur in the lower ribs happen mainly to golfers.

If you play a sport and notice pain during certain movements, see your doctor. A stress fracture may be to blame.

  • Torrengo, F., Paús, V., & Cédola, J. (2010). Fracturas por estrés en deportistas. Rev la Asoc argentina Traumatol del Deport, 18-23.