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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

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 FractureStress fractures are some of the most frequent children’s sports injuries. This condition appears usually as a small fracture to a bone in the leg or foot resulting from overuse or repeated application of force to a particular 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.

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. The development of this condition can contribute to predisposing factors such as osteoporosis and hormonal problems, further weakening the bones. Stress fractures are diagnosed using imaging tests such as MRI and bone scans.

Our doctors will recommend resting the affected area and treatment with analgesics. In some cases, our doctors may suggest surgery. As with other fractures, symptoms of stress fractures include pain, tenderness, and swelling in the affected area. Stress on the area will increase the pain, so rest is highly recommended to help healing.

What Are the Symptoms?

Stress fractures typically result in dull discomfort near the fracture. Exercise, walking, or standing are frequently the things that make this discomfort worse. Swelling of the area is another sign.

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 foot. 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.

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 get 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. 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 you 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 follow the following recommendations:

  1. Do not engage in weight-bearing exercises. If required, put on supportive shoes with a strong sole.
  2. 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.
  3. To reduce swelling, encircle the region with a gentle wrap.
  4. Raise the legs or foot over the heart by using cushions.


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.

  1. Crutches or canes for support
  2. Protective footwear such as boots and bandages to reduce stress on fractures
  3. 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.


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 too much stress 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 an 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 body 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 the high-impact activity. 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 appoint with one of our Children’s Specialists for diagnosis and treatment.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four convenient locations: Arlington, Dallas, Frisco and McKinney.