What Is a Stress Fracture—and How Do You Know If You Have One?

A stress fracture rarely begins with the dramatic moment people associate with a broken bone. There may be no fall, collision, or sudden snap. Instead, you notice an ache during a run. It disappears when you stop, so you train again the next day. A few workouts later, the same spot hurts sooner, feels tender when you press on it, or starts bothering you during ordinary walking.

That gradual progression is one reason stress fractures are easy to mistake for a muscle strain, shin splints, or routine training soreness. Athletes may assume they simply need to stretch more or push through until their body adjusts. Unfortunately, continuing to load a bone that is already struggling to recover can turn an early bone stress injury into a more significant fracture. [1]

Knowing what stress-fracture symptoms actually feel like, and how they differ from other overuse injuries, can help you recognize when it is time to stop training and get evaluated.

What Is a Stress Fracture?

Bone is living tissue that continually responds to the forces placed on it. Exercise creates microscopic stress, and recovery gives the body time to repair and adapt to that load. When repetitive stress accumulates faster than the bone can recover, however, a bone stress injury can develop. [1]

The earliest stage is often called a stress reaction. The bone has become overloaded and may show swelling or other changes, but there is not yet a clear fracture line. If the repetitive loading continues, the injury can progress until a small crack develops in the bone. That is a stress fracture. [1]

Most athletic stress fractures are fatigue injuries, meaning repetitive force overwhelms bone that is otherwise healthy. Stress fractures can also occur when the bone itself has been weakened by a condition such as osteoporosis. In that situation, even normal everyday activity may be enough to create what is known as an insufficiency stress fracture. [1]

If you are concerned about underlying bone strength rather than a training-related injury alone, our article on bone density after 40 explains the factors that influence long-term bone health and fracture risk.

Where Do Stress Fractures Usually Happen?

Stress fractures can occur in different bones depending on the activity involved, but the weight-bearing bones of the lower body are particularly vulnerable. Runners, dancers, basketball and soccer players, military recruits, and athletes involved in repetitive running or jumping are commonly affected. [1][2]

In the foot and ankle, the metatarsals are common locations. Stress fractures can also occur in the heel bone, fibula, navicular, talus, and small sesamoid bones beneath the big toe. The tibia, or shinbone, is another common location in athletes. [2]

NYBJ’s guide to running-related foot injuries discusses several conditions that can develop when running volume or intensity increases faster than the body is prepared to tolerate.

What Does a Stress Fracture Feel Like?

One of the most useful clues is that stress-fracture pain is often focused rather than vague.

In the early stages, you may notice discomfort in one specific area near the end of a workout or shortly afterward. The pain often improves with rest, which makes it easy to assume the problem is minor. [1]

As the bone stress injury becomes more advanced, symptoms may start earlier during exercise and take longer to settle afterward. Eventually, the area can hurt during normal walking or everyday activities. Some people develop swelling, bruising, a limp, or aching at night as the injury worsens. [1]

Common stress-fracture symptoms include:

• Pain focused over a relatively small area of bone
• Pain that increases during running, jumping, or other weight-bearing activity
• Tenderness when pressure is applied directly over the painful bone
• Symptoms that initially improve with rest but return when activity resumes
• Swelling around the painful area in some cases
• Pain during ordinary walking as the injury becomes more severe
• A limp when weight-bearing becomes uncomfortable

The pattern is often more useful than any one symptom. A stress fracture typically becomes increasingly difficult to ignore if the same loading continues.

Stress Fracture vs. Shin Splints: What’s the Difference?

Shin pain creates one of the most common diagnostic questions in runners: is it a stress fracture or just shin splints?

Shin splints, also called medial tibial stress syndrome, generally cause pain along the inner border of the tibia. AAOS describes the condition as involving the muscles, tendons, and bone tissue around the shinbone after repetitive overuse. [3]

A tibial stress fracture is an injury within the bone itself. While both can occur after a sudden increase in training and both can hurt during exercise, the distribution of the pain is often different.

	Stress Fracture	Shin Splints
What is injured?	Bone stress injury that has progressed to a small crack in the bone [1]	Overuse-related irritation involving muscle, tendon, and bone tissue around the tibia [3]
Where is the pain?	Usually focused over a specific area of bone	More commonly extends along a broader area of the inner shin
When does it hurt?	Often begins with activity, improves with rest early on, and can become more persistent as the injury progresses [1]	Commonly hurts during and after exercise [3]
Tenderness	Often very localized directly over the injured bone [1][2]	More commonly follows the inner border of the tibia [3]
Swelling	Can occur	Mild swelling may occur
Imaging	Early X-rays can be normal; MRI can identify an occult bone stress injury [1][4]	Usually diagnosed clinically; imaging may be used to rule out a stress fracture or another cause of shin pain [3]

This comparison can point you in the right direction, but it should not be used as a home diagnostic test. There is overlap between these conditions, and persistent shin pain can also result from tendon problems or chronic exertional compartment syndrome. [3]

If pain becomes very localized, continues to worsen, or stops behaving like typical training soreness, an orthopedic evaluation is appropriate.

Why Stress Fractures Often Happen After a Training Change

Stress fractures are less about one hard workout than the relationship between loading and recovery.

A sudden increase in activity is one of the most common triggers. That might mean increasing weekly mileage, adding more training days, introducing hill work, starting a new high-impact workout, or returning to a sport after time away. Even someone who is not an athlete can develop a bone stress injury after abruptly doing far more walking than usual. [1][2]

Training surface and footwear can also alter how forces move through the lower extremity. NYBJ’s running injury prevention guide discusses why rapid training increases and repetitive impact can create problems for runners.

The issue is not that exercise is bad for bone. Appropriate loading actually helps bone adapt and become stronger. Problems develop when the increase in stress outpaces the body’s ability to recover.

Other Risk Factors Are Worth Looking At

Training volume is only part of the picture. Some athletes develop bone stress injuries even though their workout plan does not initially appear extreme.

AAOS identifies several additional factors that can increase risk, including inadequate recovery, low energy intake relative to the amount of exercise being performed, low vitamin D levels, muscle weakness or fatigue, altered biomechanics, worn footwear, and previous injury. Low bone strength from osteoporosis or certain medical conditions and medications can also make stress injury more likely. [1]

For athletes, nutrition deserves particular attention. Relative Energy Deficiency in Sport, or RED-S, occurs when energy intake is insufficient to support both training and normal physiological function. Low energy availability can negatively affect bone health and increase the risk of bone stress injury. [1]

A first stress fracture may simply follow an obvious training error. Recurrent stress fractures or a fracture that develops during relatively light activity may warrant a broader look at bone health, nutrition, medications, and other contributing factors.

Can You Diagnose a Stress Fracture Without Imaging?

Symptoms and examination findings can create a strong suspicion, but imaging is often used to confirm the diagnosis or determine how extensive the injury is.

During an orthopedic evaluation, your doctor will ask about your training, recent activity changes, the exact location of the pain, when symptoms occur, and whether they improve with rest. The examination generally includes checking for focal tenderness over the bone and assessing how the affected leg or foot functions. [1][2]

A clinician may use movement or loading tests as part of the examination, but repeatedly jumping or running on a painful leg at home to “test” whether you have a stress fracture is not a good strategy. If loading the area is causing increasingly focal bone pain, stop the aggravating activity and have it evaluated.

Will a Stress Fracture Show Up on an X-Ray?

Sometimes, but not always.

X-rays are generally the first imaging study when a stress fracture is suspected. The problem is that an early bone stress injury may not yet create changes that are visible on a standard X-ray. The fracture can become easier to see several weeks later as healing changes develop around the area. [1][2]

This means a normal early X-ray does not automatically rule out a stress fracture.

The American College of Radiology recommends radiography as the usual initial imaging study for a suspected stress fracture. When the X-rays are negative or inconclusive but clinical suspicion remains, MRI without contrast is generally considered the appropriate next imaging study. [4]

MRI can identify bone marrow changes associated with a stress injury before a fracture becomes obvious on an X-ray. CT and other imaging methods may also have a role in selected cases depending on the bone involved and the question your physician needs answered. [2][4]

Why the Location of the Stress Fracture Matters

Not every stress fracture behaves the same way.

Some occur in areas with favorable blood supply and tend to heal reliably when the bone is protected from excessive loading. Others occur in locations where healing can be slower or the risk of progression is greater. Stress fractures involving areas such as the navicular or certain parts of the fifth metatarsal may require more restrictive treatment and, in selected cases, surgery. [2]

This is one reason guessing at the diagnosis and continuing to train can be risky. Two athletes may both say they have “foot pain,” but the appropriate treatment can be very different depending on which bone is involved.

NYBJ provides evaluation and treatment for fractures and other bone injuries at its Manhattan orthopedic centers.

Can You Walk on a Stress Fracture?

There is no single answer for every stress fracture.

Some lower-risk injuries may allow a degree of protected weight-bearing during recovery, while others require a walking boot, crutches, or a period of avoiding weight through the injured area. The location and severity of the injury determine how much loading is safe. [1][2]

What is not recommended is continuing the activity that is reproducing the pain simply because you can still walk through it.

AAOS warns that returning to high-impact activity too quickly can delay healing and increase the risk of a stress fracture progressing to a complete fracture. [2] If ordinary walking is painful, you are limping, or the pain is increasing, that is a strong reason to have the injury assessed.

Our corresponding All Sports Physical Therapy article, Stress Fracture Recovery: The PT Protocol That Gets Athletes Back Faster, looks more closely at how rehabilitation progresses once the fracture has been diagnosed and the bone is ready for increasing levels of activity.

What Should You Do If You Think You Have a Stress Fracture?

The first step is to stop repeatedly loading the painful area.

Do not continue running, jumping, or practicing through increasingly focal bone pain while waiting to see whether it disappears. Early recognition can prevent a smaller bone stress injury from progressing into a more significant fracture. [1]

Until you can be evaluated:

• Stop the activity that produces the pain
• Avoid repeatedly testing the painful area with running or jumping
• Reduce weight-bearing if ordinary walking is painful
• Use ice for swelling if needed
• Schedule an orthopedic or foot and ankle evaluation

The next step depends on the diagnosis. Treatment may involve activity restriction, protected weight-bearing, a walking boot, crutches, or another form of immobilization. More complex or higher-risk stress fractures sometimes require surgical treatment. [1][2]

When Should You See an Orthopedic Specialist?

Stress fractures are easier to manage when they are recognized before the injury progresses.

Consider scheduling an evaluation if:

• Pain repeatedly occurs in the same spot during exercise
• The painful area is sharply tender directly over a bone
• Symptoms are appearing earlier during each workout
• Pain has started occurring during normal walking
• You have swelling around a focal area of the foot or leg
• You are limping
• Symptoms persist despite reducing your activity
• Your shin pain is becoming more localized instead of improving
• You have had multiple stress fractures
• Bone pain developed without a significant increase in activity

New York Bone & Joint Specialists’ foot pain specialists and sports medicine physicians evaluate stress fractures and other overuse injuries in athletes and active New Yorkers.

If your pain followed a sudden injury rather than developing gradually, or you cannot bear weight normally, NYBJ also offers orthopedic urgent walk-in care for acute musculoskeletal injuries.

Don’t Train Through Bone Pain

Athletes are accustomed to some discomfort. Muscles get sore. Training days feel harder than others. Minor aches often improve as your body adapts.

Bone pain deserves a different level of attention.

A stress fracture can begin subtly enough that taking a few days off feels overly cautious. But if the same pinpoint pain returns each time you run, jump, or load the area, continuing to train can make the injury more difficult to treat. The goal is not to prove you can tolerate the pain. It is to recognize when the bone needs time and appropriate treatment to recover.

If you have persistent, localized pain that worsens with activity, schedule an evaluation with New York Bone & Joint Specialists to determine whether a stress fracture or another overuse injury may be responsible.

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Frequently Asked Questions

What are the first symptoms of a stress fracture?

An early stress fracture often causes discomfort in one specific area of bone during or near the end of physical activity. The pain may initially disappear with rest but return when the same activity is resumed. As the injury progresses, pain can occur earlier during exercise and eventually during normal walking or everyday activity. [1]

How can I tell if I have shin splints or a stress fracture?

Shin splints usually cause tenderness and pain across a broader area along the inner edge of the tibia, while a stress fracture is more likely to cause focal pain and tenderness over a smaller area of bone. The symptoms can overlap, however, so persistent or increasingly localized shin pain should be evaluated. [1][3]

Can you have a stress fracture and still walk?

Yes, some people can still walk with a stress fracture, particularly in the earlier stages. Being able to walk does not rule out the injury. If walking becomes painful or causes a limp, the bone may need additional protection from weight-bearing. [1][2]

Will an X-ray always show a stress fracture?

No. Early stress fractures frequently do not appear on standard X-rays. X-rays are generally the first imaging study, but MRI may be appropriate when radiographs are negative or inconclusive and a stress fracture is still suspected. [1][4]

Does a stress fracture hurt all the time?

Not necessarily. Early bone stress injuries often hurt primarily with activity and improve with rest. More advanced injuries can cause pain during normal walking, everyday tasks, and sometimes even at night. [1]

Can a stress fracture turn into a complete fracture?

Yes. Continued repetitive loading can allow a bone stress injury to progress. AAOS warns that returning to impact activity too early can delay healing and increase the risk of a complete fracture. [1][2]

Can you get a stress fracture without being an athlete?

Yes. A sudden increase in ordinary activity, such as significantly more walking than usual, can create a bone stress injury. People with weakened bones may also develop insufficiency stress fractures during activities that would not normally overload healthy bone. [1][2]

Why do stress fractures keep happening?

Recurrent stress fractures may be related to training load, inadequate recovery, low energy intake, biomechanics, nutrition, low bone density, medications, or other medical factors. Multiple bone stress injuries are a reason to look beyond the individual fracture and assess why the bone may be repeatedly becoming overloaded. [1]

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References

[1] American Academy of Orthopaedic Surgeons. Stress Fractures. OrthoInfo.

[2] American Academy of Orthopaedic Surgeons. Stress Fractures of the Foot and Ankle. OrthoInfo.

[3] American Academy of Orthopaedic Surgeons. Shin Splints. OrthoInfo.

[4] Morrison WB, Deely D, Fox MG, et al. ACR Appropriateness Criteria® Stress (Fatigue-Insufficiency) Fracture Including Sacrum Excluding Other Vertebrae: 2024 Update. Journal of the American College of Radiology. 2024;21(11S):S490-S503.

[5] American Orthopaedic Society for Sports Medicine. Stress Fractures.

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