How long does a stress fracture take to heal

In amongst everything from blisters and chafing to plantar fasciitis and IT band syndrome, there’s one injury that puts fear into the heart of runners: the stress fracture. A painful injury that strikes seemingly out of nowhere, a stress fracture is guaranteed to keep you away from the start line.

But what is a stress fracture, and how can you avoid getting one? Here’s everything you need to know about this scary sounding injury.

What is a stress fracture?

A stress fracture is a small crack, or severe bruising in a bone. They are a relatively common overuse injury in runners and over 80% of them occur in the legs of those affected. “They occur when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone causing a tiny crack called a stress fracture,” according to Dr Matthew Oliver, Consultant Trauma and Orthopaedic Surgeon at Benenden Hospital, Kent.

According to the American Academy of Orthopaedic Surgeons, “stress fractures occur most often in the second and third metatarsals in the foot, which are thinner (and often longer) than the adjacent first metatarsal. This is the area of greatest impact on your foot as you push off when you walk or run.” Stress fractures are also common in the heel, the ankle and the midfoot.

Jordan Metzl, a sports medicine physician at theHospital for Special Surgery in NewYork City, adds, "A stress reaction or a stress injury happens when the bone starts to swell inside. The worse the symptoms get and the longer you ignore them, the more likely it is to develop into a full-blown stress fracture."

What are the causes of stress fractures?

Overuse:

Unlike a sudden fall, a stress fracture will often develop over time. The repetitive force of say, running, causes microscopic damage to the bone, and if there’s not enough time for these to recover, a stress fracture can occur. "Bone needs time to get used to the increased loading force of running, so make sure you give your bones enough time," warns Metzl.

Stress fractures are generally a result of doing too much, too soon, without the body having enough time to adapt. A sudden increase of say, running more days a week or running for longer than before is one of the most common factors.

Bone density:

Conditions like osteoporosis also put runners at risk of developing a stress fracture. Studies have shown that stress fractures are more common in the winter, when we have less Vitamin D in our bodies, and that women are more at risk of developing one.

A study found that women with a low BMI are more at risk of a stress-fracture, and irregular periods in women can also pose a risk, according to Dr Mahmud Taher of London Osteoporosis Clinic.

Form:

It’s also thought that running form can have an impact on the likelihood of stress fractures in some cases. “There does seem to be a link to tibial stress fractures with those who overstride with a definite heel strike,” says physiotherapist Neil Smith. “This type of running style also increases load at the hip, increasing the possibility of femoral stress fractures.” Steady on before you make a snap decision to switch to a forefoot strike, though. “Running with a forefoot strike increases the load on the foot and ankle, which can increase the risk of stress fractures in the foot. Making the change to more minimal footwear or to a forefoot strike too quickly can increase the risk of a metatarsal stress fracture,” warns Smith.

People who overpronate are also more susceptible to stress fractures, because they put a lot more medial loading force on their legs.

Nutrition:

Insufficient nutrition can also put you at risk. Research published in The Journal of Foot & Ankle Surgery reported that low levels of vitamin D may increase the risk of stress fractures, and suggested that active individuals may need high levels of it than the general population. Low levels of calcium can also put runners at risk, along with a high caffeine intake, too much sodium in the diet and generally not eating enough to offset activity levels.

Change in surface:

If you’re a road runner who suddenly spends a lot of time on the treadmill, or vice versa, this can increase the risk of a stress fracture.

Improper equipment:

Wearing old or incorrect running shoes that have lost, or no, shock-absorbing ability may contribute to stress fractures.

What are the symptoms of a stress fracture?

The most common symptoms of a stress fracture are:

• Pain during a run that gets worse as you go.
• A sharp pain that you can pinpoint on a bony area, it might feel tender to touch.
• Pain when resting.
• Swelling on the top of the foot or on the outside of the ankle.
• Changes to your running form

A problem that comes on suddenly is a real red light, so if you’ve had no symptoms and rapidly acquire a pain that prevents you from moving normally, it’s time to take action.

Runners typically get stress fractures in their feet, shins, knees and hips. Point tenderness is when a specific bone feels sore to the touch, and performing the ‘hop test’ is a good way to identify this: carefully, hop a couple of times on the injured foot. If it hurts when you land, it could be a stress fracture.

Swelling in the affected area is another common sign. While you could see swelling anywhere, it most commonly occurs on the upper side of the foot due to a stress reaction or fracture in the metatarsals. Metzl notes that the contour of the veins on the top of the foot may be less visible when compared to the other foot.

Watch out also for changes in your biomechanics while running. If you’re in so much pain that you need to adjust your form, consult your doctor right away. "If you notice you’re not landing on your foot in the same way you usually do because it hurts too much, get it checked out," advises Metzl.

Can you run with a stress fracture?

“The most common running related stress fractures are to the tibia,” says Smith. “This is followed by fractures to the metatarsals (small bones of the foot), fibula and femur. Stress fractures can also occur in the pelvis of runners, although this is much less common.” So, an abrupt, pinpointable pain in your foot, shin, thigh or pelvis is not one to try and run through.

How do you treat a stress fracture?

The best idea is to book an appointment with your doctor ASAP. If you can’t get one quickly, the best idea is to apply RICE - rest, ice, compress and elevate the area.

Once diagnosed by a doctor, who’ll use an X-ray, CT, MRI or DEXA scan to suss out the injury, a splint may be used to support the bone as it heals. Pain can be treated using painkillers such as paracetamol and by icing the affected area.

“The most important treatment is rest,” says Oliver. “Individuals need to have a complete rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal.” If running is resumed too soon, larger fractures can develop which can lead to chronic problems in the bone.

In certain cases, a stress fracture will require surgery in order to heal completely. In most cases, this will involve supporting the bones by inserting a fastener, for example a pin, screw or plate.

Once you’ve been diagnosed, you’ll mainly want to stay off the bone and give it enough time to heal, and Metzl notes that stress fractures further away from your heart heal more slowly since they receive less blood flow. But just because you have a stress fracture doesn’t mean you can’t still exercise. You can keep your cardio-vascular fitness going by cross-training. Metzl recommends low-impact activities such as cycling or swimming, but talk with your doctor to discuss what you should and shouldn’t be doing as your fracture heals.

How long does it take for a stress fracture to heal?

It can take anything from six to eight weeks for a fracture to fully heal. In the meantime, low impact exercise such as cycling and swimming can be taken, as long as your doctor considers you ready and you take on the extra activity gradually. Having a gait assessment from an experienced physio as you begin running again can help pin down any biomechanical issues that could put you at risk of re-injury.

How can I avoid stress fractures?

Increase exercise slowly: “My biggest training tip of all would be to make all changes gradually,” says Smith. “Advanced planning for any training programme is a great way to prevent stress fractures. Set yourself a mini 4-6 week pre-training programme involving very gradual increase in mileage.”

Oliver agrees, saying “When participating in any new sports activity, set incremental goals. For example, do not immediately set out to run five miles a day; instead, gradually build up your mileage on a weekly basis.”

If you haven’t run more than four or five miles in a few months, don’t suddenly jump up to
a 20-mile run. Experts recommend increasing your weekly mileage by no more than 10 per cent each week.

Metzl also recommends shortening your running stride and quickening your cadence. A stride of 80-90 steps per minute for one foot (160-180 for both feet) can decrease your chance of injury.

Visit a physio

Research suggests that treating biomechanical flaws can help prevent stress fractures. Visit a physio to get an assessment of your running technique and pick up prehab exercises to correct any issues before they escalate.

Vary the surface of your runs

“Varying the surface that you run on can also help to prevent stress fractures, as can substituting a ‘recovery run’ session with cross training such as swimming or cycling,” Smith adds. “Most importantly, when planning a training programme, be realistic with your distance and speed targets.”

Eat a healthy diet

Make sure that you get enough calcium in your diet to prevent osteopenia or osteoporosis. Adult runners should aim for 1,000 milligrams of calcium per day – a good source should have at least 100 milligrams per serving. Foods such as yoghurt, milk, cheese, tofu and dark, leafy greens are all great options.

Add strength training to your running plan

One of the best ways to prevent muscle fatigue and the loss of bone density is strength training. Use our runners guide to strength training to ensure you’re doing enough.

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