Epidemiology

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Etiology

Mechanism

• Normal bone develops a fracture as a result of bone remodeling due to repetitive microtrauma.

Risk factors

• Participation in repetitive high-intensity physical activity: often seen in athletes and military recruits, and children and adolescents participating in year-round sports
• Improper technique during physical activity
• Ill-fitting footwear
• Poor nutrition and/or low calorie intake (e.g., in anorexia nervosa)
• Low bone mineral density (e.g., from bisphosphonate use)
• Calcium and/or vitamin D deficiency
• Female sex

Tip

The female athlete triad syndrome is associated with an increased risk of stress fractures.

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Pathophysiology

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Clinical features

• Lower extremities (most common): tibia, tarsal navicular, metatarsals (march fracture), femur, fibula, pelvis
• Pain that worsens with activity and resolves with rest
• Focal bone tenderness, erythema, and/or soft tissue swelling

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Diagnostics

• X-ray: recommended initial imaging study
  • Radiographic features of stress fractures include:
    • Fracture line: line of faint lucency
    • Indirect features: periosteal thickening, increased cortical density, formation of a callus, endosteal thickening and/or sclerosis
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  • Often normal in the first 2–3 weeks of disease onset

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Treatment

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