STRESS FRACTURES
Stress fractures are tiny cracks in a bone — most commonly, in the weight-bearing bones of the lower leg and foot. They’re caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances.
At Medical City Children’s Orthopedics and Spine Specialists, our expert Stress Fracture Doctors are dedicated to diagnosing and treating spinal problems in children and ensuring comprehensive care tailored to each patient’s needs. With advanced techniques and a compassionate approach, our team is here to diagnose, treat and care for children suffering from Stress Fractures.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
What Is a Stress Fracture?
Stress fractures are tiny cracks in a bone, most commonly in the weight-bearing bones of the lower leg and foot. They’re caused by repetitive force, often from overuse, such as repeatedly jumping up and down or running long distances. If your child needs surgery or a cast, our Fracture Care Clinic is open every day, and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Stress fractures are some of the most frequent children’s sports injuries. This condition typically presents as a small fracture to a bone in the leg or foot, resulting from overuse or repeated stress applied to a specific bone. They are commonly found in the lower extremity bones of those involved in sports. Fractures usually occur after obvious trauma to the bone. However, for stress fractures, there is no obvious trauma. They can result in pain, but usually heal on their own after a few months of rest.
Where do Stress Fractures occur
Normal human bones undergo a constant remodeling process. Minor damage to the bone is replaced by new bone, and most of the normal structure is preserved. When children play hard and engage in competitive sports, their bones, especially their lower extremities, don’t get enough time to rest and repair. As a result, the extreme stress causes tiny cracks, leading to stress fractures.
This is especially evident in the bones of the foot, leg, and pelvis. These bones need to absorb the forces created from walking, running, and jumping. Up to 12 times the weight of the body may be generated with each step, and the bones, joints, muscles, and ligaments need to cushion the body against that force. When these structures are pushed beyond their ability to handle repetitive impact—without enough time to recover—stress fractures can develop.
The development of this condition can contribute to predisposing factors such as osteoporosis and hormonal problems, further weakening the bones.
QUESTIONS AND ANSWERS
What is a stress fracture, and how did my child develop one?
A stress fracture is a tiny crack or hairline break in a bone, typically caused by repetitive stress or overuse. In children and adolescents, stress fractures often result from activities that place repetitive stress on a specific bone. Common causes include participation in sports with repetitive impact, sudden increases in physical activity, or improper technique during exercise. It’s essential to understand the specific activities that may have contributed to the stress fracture to guide the treatment plan and prevent future occurrences.
How is a stress fracture diagnosed, and what tests are required?
Diagnosis of a stress fracture usually involves a combination of a thorough physical examination and imaging studies. During the physical exam, the doctor may assess the child’s symptoms, perform a focused examination of the affected area, and inquire about recent activities or changes in physical activity levels. X-rays are commonly used to detect stress fractures, but they may not show up immediately. In some cases, additional imaging studies such as MRI or bone scans may be necessary for a more accurate diagnosis. A healthcare provider may also consider the child’s medical history and activities when making a diagnosis.
What is the treatment plan for my child's stress fracture, and what is the expected recovery time?
Treatment for a stress fracture typically involves a combination of rest, activity modification, and pain management. The specific treatment plan will depend on the location and severity of the stress fracture. Common recommendations include:
- Rest: The child may need to temporarily refrain from the activities that caused the stress fracture to allow for proper healing.
- Immobilization: In some cases, bracing, splinting, or the use of crutches may be recommended to prevent further stress on the affected bone.
- Pain Management: Over-the-counter pain medications or prescribed pain relievers may be used to manage pain and inflammation.
- Gradual Return to Activity: Once the stress fracture has healed, the child can gradually resume physical activity under the guidance of healthcare professionals.
It’s crucial for parents to follow the prescribed treatment plan and communicate any concerns or changes in symptoms to the healthcare provider. Additionally, understanding the importance of proper rest and gradual return to activity can help prevent future stress fractures.
The doctors at Medical City Children’s Orthopedics and Spine Specialists, are experts in treating stress fractures. To ensure your child’s bones heal properly, call us for an appointment
How Does Healing Differ Between Stress Fractures and Complete Fractures?
Treatment and healing for stress fractures often look quite different from what’s needed for complete fractures. For most children with a stress fracture, the first step is to limit activities that put stress on the affected bone. This usually means taking a break from running, jumping, or high-impact sports for several weeks. Doctors may prescribe a walking boot, brace, or crutches to reduce weight-bearing and give the bone time to repair.
A key point: if a stress fracture is allowed to rest, it typically heals well and relatively quickly, without long-term consequences. However, if the bone is pushed too soon—by returning to sports before healing is complete—the damage can worsen and progress to a complete fracture. Complete fractures are more serious and require a much longer recovery, sometimes needing casting, prolonged immobilization, or even surgery in more severe cases.
Protecting the bone in the early stages and allowing enough rest is essential for stress fractures to heal efficiently and prevent more significant injury.
What Are the Symptoms?
Stress fractures in children and teenagers occur when repetitive stress or overuse causes small cracks in bones, often in the legs or feet. Symptoms include:
- Pain: Localized pain worsens with activity, like running or jumping, and eases with rest.
- Tenderness: The affected area feels sore when touched or pressed.
- Swelling: Mild swelling or inflammation appears around the injury site.
- Discomfort During Movement: Pain increases during weight-bearing activities, such as walking or standing.
- Limping: The child may limp or avoid using the affected limb to reduce pain.
- Stiffness: The area feels stiff, especially after periods of rest or inactivity.
In children and adolescents, symptoms may be subtle at first, as their growing bones are more flexible but still prone to overuse injuries. Pain often starts gradually and may be mistaken for muscle soreness. If untreated, symptoms can worsen, potentially leading to a complete fracture. If you suspect a stress fracture, consult a doctor for diagnosis and management. Would you like details on diagnosis or treatment?
What Causes Stress Fractures?
Stress fractures are more likely to occur in several sports. Running and jumping-intensive activities might result in this condition in the legs or feet. Lower leg bones are the site of more than half of all stress fractures in children and adolescents. The longest bone in our lower leg, the tibia, accounts for around 24% of all stress fractures. The condition can occur in the arm bone in sports that call for repetitive actions, like pitching or rowing, although these are considerably less common.
The most common sites for stress fractures in the foot are the metatarsal bones. These tiny cracks develop gradually when repetitive forces—such as continuous running, repeated jumping, or even frequent changes in direction—cause microscopic damage to the bone without giving it enough time to repair. Over time, this ongoing stress accumulates, often resulting in pain and tenderness that worsens with activity. In children and adolescents, this is especially common in sports like basketball, soccer, track, and gymnastics, where the lower extremities are under frequent impact.
Recognizing the activities and motions that may have contributed to the fracture is important for both treatment and prevention. Understanding which bones are most at risk and how repetitive stress builds up over time can help guide your child’s recovery and safe return to play.
How Does Changing Playing Surfaces Contribute to Stress Fractures?
A sudden switch in training or playing surfaces can put unexpected stress on a child’s bones. For example, moving from a softer surface like grass to a harder one, such as concrete or asphalt, increases the impact forces on the legs and feet with every step or jump. This heightened stress can challenge the body’s normal bone remodeling process, making it harder for bones to recover between activities.
Athletes—particularly runners who shift from indoor treadmills to outdoor tracks, or tennis players who switch from clay courts to artificial turf—are especially at risk. When the surface doesn’t “give” as much underfoot, bones absorb more force, and tiny cracks may appear. Gradual adaptation and mixing in rest days can help, but abrupt changes raise the risk for stress fractures, especially when combined with an intense schedule or improper footwear.
What Increases Your Child’s Chances of Stress Fractures?
Children and those in their early teens who have just begun a new activity or quickly increased the intensity of their sports activity are considerably more prone to stress fractures. Lack of conditioning causes the muscles to fatigue quickly and perform poorly in terms of supporting and cushioning the bones. More pressure is placed directly on the bones, which increases the risk of fracture. Girls tend to get stress fractures more frequently.
This is often linked to what doctors refer to as the " female athlete triad," a combination of conditions that can affect young female athletes who push themselves to extremes in training or dieting. The triad includes eating disorders, menstrual irregularities, and decreased bone density (premature osteoporosis). When a girl’s bone mass drops due to these factors, her risk of developing a stress fracture climbs significantly. In these cases, the body doesn’t get the nutrients or hormone support needed for strong, healthy bones, making girls especially vulnerable during periods of rapid growth or intense physical activity.
Other variables that increase the incidence of this condition include:
- Over 25 kilometers of running each week
- Eating disorders
- Low levels of vitamin D
Any physical abnormality, such as falling arches, might unevenly transfer stress across the feet and legs. Poor-quality gear, such as scuffed or worn-out running shoes, can also cause injury.
How Are Stress Fractures Diagnosed?
Our doctor will do a physical examination to identify a stress fracture, and X-rays will help the doctor fully understand the injury. In order to further diagnose your child’s injury, the doctor could utilize MRIs, nuclear bone scans, or other imaging techniques.
What Is the Treatment?
First aid for stress fractures
It’s crucial to visit one of our doctors since, if left untreated, the bone might entirely shatter. In the meantime, the parents should ensure the child follows the following recommendations:
- Do not engage in weight-bearing exercises. If required, put on supportive shoes with a strong sole.
- Ice the region for 24 to 48 hours to reduce swelling. Apply an ice pack for 20 minutes at a time while wrapping it in a towel.
- To reduce swelling, encircle the region with a gentle wrap.
- Raise the legs or feet over the heart by using cushions.
Medications
To treat pain, parents can buy over-the-counter medicines. Doctors recommend acetaminophen as an alternative to Nonsteroidal anti-inflammatory drugs (NSAIDs), which can affect a bone’s ability to heal.
Nonsurgical Treatments
Most children do not need surgery to repair stress fractures. In addition to the pain relief plan, your doctor may try one or more of the following treatments while the fracture heals.
- Crutches or canes for support
- Protective footwear, such as boots and bandage,s to reduce stress on fractures
- A plaster cast keeps the fracture in place until it heals
They also advise skipping high-impact physical activities such as running for 6 to 8 weeks. Instead, low-impact exercises such as swimming or biking may be ok.
Surgery
Severe stress fractures that do not heal on their own may require surgery. Most often, doctors use fasteners such as pins, screws, plates, or a combination of these to hold the small bones of the foot and ankle together.
Recovery and Healing
It commonly takes 6 to eight weeks for a stress fracture to heal. Doctors may take X-rays when the pain subsides to make sure the fracture has healed. When the swelling has subsided enough to reveal skin folds, a patient can begin to put some weight on the area. Patients can also use crutches or a cane to avoid stress on the fracture. Usually, a child or adolescent with a stress fracture can put weight on the area 2 weeks after the onset of symptoms. A little weight-bearing helps heal stress fractures, and pain will stop when too much stress is placed on the area. For 6 to 8 weeks after the injury or until the pain is gone, patients should avoid the activity that caused the condition.
Resuming exercise too soon can delay the healing process and can even cause damage. Early on, our doctor can prescribe alternating running days. If your child is a runner. That also means resting before and after jogging. Be aware that if your child rushes back, your child may get hurt again because stress fractures tend to recur. About 60% of children who have a stress fracture have had one before.
How Can Stress Fractures Be Prevented?
Stress fractures are common in children who have dramatically increased their level of physical activity. So, to prevent them, ensure your child goes back to sports slowly. Experts recommend not increasing exercise intensity by more than 10% per week. Before working out, your child should spend some time warming up and stretching. Children should take regular breaks to rest their bodies, and they should stop exercising if they have pain. Vigorous sports increase the risk of stress fractures. Good exercise equipment also helps prevent stress fractures. Do not let your kids wear worn running shoes. Children with flat feet or other anatomical problems may benefit from using custom insoles and arch supports in their shoes.
What Distinguishes Shin Splints from a Stress Fracture of the Shin?
When the pain begins, parents may find it difficult to determine whether the child has a stress fracture or shin splints. Both are brought on by overtraining, a sudden increase in exercise intensity, or weight-bearing activities. Both are typical of runners.
Shin Bone Stress Fracture
There is a break in your child’s shin bone if your child has a stress fracture of the shin. When your child puts weight on his or her legs, walks, or runs, pain may be localized to a small region and will worsen. Even when your child is at rest, pain may continue.
Shin Splints
Despite an undamaged bone, shin splints cause inflammation of the muscles, tendons, and bone tissue. A bigger area of the shin bone may experience discomfort and soreness as a result. Even while your child might not experience much pain while at rest or when walking or engaging in other low-impact activities, discomfort spikes when engaging in high-impact activities. Home treatment options for shin splints include ice, rest, and avoiding high-impact activities until they get better. A bone fracture might also result from trying to participate in certain sports.
Final Words
Shin stress fractures are thin fractures caused by repetitive, high-impact exercise. Treatment includes getting plenty of rest and stopping strenuous exercise until healing. Fractures that are severe or difficult to heal may require the use of crutches, a cast, or surgery. Full recovery takes 4-12 weeks. If your child is involved in lots of running, there are a few things you can do right now to reduce the chances of a tibia stress fracture. Finally, if your child experiences shin splints or swelling, make an appointment with one of our Children’s Specialists for diagnosis and treatment.
Schedule An Appointment For Your Child’s Stress Fracture Evaluation
If you think that your child may have a stress fracture, taking them to a pediatric orthopedist like us at the Medical City Children’s Orthopedics and Spine Specialists with special low-radiation X-ray capabilities is the right step to take. The specialist will check out the spot that is paining the child, and our doctors will also carry out the necessary examination for the correct diagnosis and treatment. If you are in the Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX areas, please give us a call and bring your child to the office that is closest to you, where our state-of-the-art diagnosis system will help to detect the cause behind your child’s pain.
Our board-certified physicians and fellowship-trained orthopedic surgeons will provide comprehensive care for your child’s needs. Our specialists are adept at caring for children, and they can provide your child with the required casting, splinting, or surgery that will tackle the pain. We provide personalized stress fracture treatment that will address the specific needs of your child.
To learn more about how we can help with your child’s stress fracture, schedule a consultation today by calling our office at 214-556-0590.
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Footnote:
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