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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Most people think of a fracture as an event that occurs when a single, large force is placed upon a bone and it breaks. Stress fractures, however, are caused by repetitive forces placed upon a bone over time that are greater than the bone can bear, and overwhelm the ability of the bone to repair itself in time to absorb the next force.

Most commonly, stress fractures occur as an overuse injury in athletes or in military recruits, but they can occur any time the lower extremities of the body are overburdened. Bones of the feet, shin, thigh, and pelvis are at greatest risk for stress fractures.

Because of the increased potential for osteoporosis in women, they are twice as likely as men to sustain a stress fracture. As people age, their bone mineral density decreases and places them at greater risk of stress fracture.

The risk of developing a stress fracture increases if the body design is unable to absorb the forces of walking, running, or jumping; or if the bone is in a weakened condition before the force is applied. Some examples include:

• height and weight (in a tall or heavy person, more force has to be absorbed by the legs);
  
  
• improper muscle or bone alignment from the back to the feet decreases the bones ability to absorb the shock or force applied;
  
  
• muscle weakness or fatigue that prevents the muscles from assisting in absorbing the force generated; and
  
  
• weak bones; common causes may include osteoporosis or bones weakened because of medication (an example would include long-term use of corticosteroids such as prednisone).

Stress fractures may occur because of overuse injuries and the failure to have adequate equipment to protect the body. Certain fractures are more sports-specific. Runners can develop stress fractures of the tibia, while tennis and basketball players more often injure the navicular bone in the foot. Poorly cushioned shoes can contribute to a stress fracture, as can training on excessively hard surfaces such as concrete.

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