A podiatrist explains what you should know about the common yet confusing injury.
In October of my junior year of high school, I was at the top of my cross-country game. I was running five to six days a week, knocking more and more time off my mile split, and gearing up for a big race that would finally prove I had what it took to hit varsity status. So when opportunities arose to run a few extra miles and push myself harder, I took them without a second thought.
Then came the day of the race. I’d been noticing some pain and throbbing in my shins for a few days, but assumed I just had shin splints—something I’d dealt with many times in the past. So before my event, I popped a couple of Ibuprofen and visualized myself totally dominating the race. Spoiler: That’s not what happened.
When the race started, I took off and headed to the front of the pack. I kept up my pace as I wove through the trail, adrenaline surging through my body. That is, until about mile 1, when my runner’s high was interrupted by an excruciating pain in my left shin.
I tried to ignore it, unwilling to give up just yet. But the pain only got worse, and soon I was limping. Girls passed me left and right, but I kept hobbling my way across the grassy path until I reached the finish line and collapsed.
Fast forward through two doctor's visits, an X-ray, and a bone scan. The verdict was that I had seven small stress fractures in my left shin.
My case is certainly nothing out of the ordinary. In fact, ABPM-certified podiatrist Melissa Lockwood, DPM, says nearly one in five runners she sees is for a stress fracture. But why do young, healthy people end up with this injury? Here, she explains what causes stress fractures, and shares tips for preventing and treating them.
What is a stress fracture?
Stress fractures are characterized as "overuse injuries." They occur when a bone experiences repeated, unusual force, says Dr. Lockwood, who's based in Bloomington, Illinois: “For example, when runners increase their distance and speed—basically anything that changes the amount of pressure they’re putting on the body.”
Dr. Lockwood typically sees these injuries happen in the metatarsals, which are the small bones right behind your toes, and the lower leg (as in my case). According to the American Academy of Orthopedic Surgeons, more than 50% occur in the lower leg.
While stress fractures are associated with running, “they can also be caused by regular force, if the bones are weakened by other problems, such as osteoporosis or another systematic problem like an eating disorder,” adds Dr. Lockwood. Research suggests women are more susceptible, possibly because they're more prone to the above-mentioned conditions.
But really, stress fractures can affect anyone. Dr. Lockwood got one in her foot after walking around Disney World all day. (See her X-rays below.)
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What are the symptoms of a stress fracture?
“The biggest thing is to watch for increased pain with increased activity,” says Dr. Lockwood. “Meaning it doesn't hurt so badly first thing in the morning, but then the more you’re on it throughout the day, or after you go for a run, the pain gets worse, even excruciating.”
Unlike a strain or pull, the ache associated with stress fractures doesn't tend to resolve itself after a couple of days, or go away with rest. So if you still feel a throbbing pain after sitting down, that’s also pretty good indicator.
But diagnosing a stress fracture can get a bit tricky: “Typically you can’t see a stress fracture on an X-ray until two weeks after the initial injury.” For that reason doctors often order other tests, like an MRI or bone scan, to identify the injury.
If a patient describes stress fracture symptoms, Dr. Lockwood always treats it as one, she says, unless she figures out an alternative explanation.
RELATED: 4 Ways to Ward Off Shin Splints
How can you prevent a stress fracture?
Once you’ve had one stress fracture, it puts you at greater risk for another, says Dr. Lockwood. [Insert un-amused emoji here] But luckily, there are a number of smart strategies you can use to keep your bones healthy.
For starters, invest in solid sneakers. If you’re a runner, head to a running store and find a pair that works optimally for your stride and foot type.
It’s also crucial to retire your shoes after a certain amount of use, Dr. Lockwood warns. Either toss them based on time (no more than 6 months) or miles (no more than 300).
And whether you’re an athlete or not, if you’ve suffered a stress fracture in the past, you may want to consider getting custom orthotics to make sure you’re moving with the right biomechanics, says Dr. Lockwood.
At the time of my own injury, I was stupidly wearing a pair of sneakers that were past their expiration date. So please, don’t make the same mistake, and actually pay attention to your shoes!
Don’t get discouraged
After my injury, I felt really down. I worried that my body wasn’t cut out for running, and that this was a sign I needed to throw in the towel.
But as Dr. Lockwood puts it, “having stress fractures does not mean your running career is over.” It may mean you need to change how you’re training, whether that’s adjusting the distance or frequency of your runs, or running on softer surfaces (think grass vs. concrete).
For me, getting back into running entailed everything Dr. Lockwood mentioned: scaling back my runs, paying better attention to my form, and regularly swapping out my shoes. Today running is still a huge part of my lifestyle. I even run-commute to work sometimes. But I'm much better about listening to my body now, and taking notice when it needs a break.
If you sense that something is off with your body, “don’t sit and wait to get it checked,” says Dr. Lockwood. “Or rather, don’t run and wait.”