Stress Fracture Risk Factors

There are a number of factors that can increase an athlete’s chance of developing a stress fracture. Non-active people can also develop stress fractures, so participation in athletics is not necessarily a prerequisite.

Risk factors for stress fracture include, but are not limited to:

• Playing certain sports; track and field sports pose the highest risk for developing stress fractures, followed by dance, soccer, and basketball¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.
• Military participation, especially during basic training¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,2Martinez, JM. Stress fractures. May 23, 2013: Medscape. http://emedicine.medscape.com/article/1270244-overview. Accessed December 23, 2014.
• Female gender³Kishner S. Physical medicine and rehabilitation for stress fractures. January 27, 2014: Medscape. http://emedicine.medscape.com/article/309106-overview. Accessed December 22, 2014.^,4American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine. Stress fractures. October 2007: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00112. Accessed December 22, 2014.
• Caucasian or Asian race, as lighter-skinned people are at higher risk of lower bone density due to poor Vitamin D production and absorption¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,3Kishner S. Physical medicine and rehabilitation for stress fractures. January 27, 2014: Medscape. http://emedicine.medscape.com/article/309106-overview. Accessed December 22, 2014.
• Low bone density, especially in women whose menstrual cycles are suppressed due to low body fat percentage and/or natural menopause³Kishner S. Physical medicine and rehabilitation for stress fractures. January 27, 2014: Medscape. http://emedicine.medscape.com/article/309106-overview. Accessed December 22, 2014.^,5Beck, B. Stress fractures. American College of Sports Medicine, Current Comments. https://www.acsm.org/docs/current-comments/stressfractures.pdf. Accessed December 23, 2014.
• Uneven leg and/or foot alignment¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,5Beck, B. Stress fractures. American College of Sports Medicine, Current Comments. https://www.acsm.org/docs/current-comments/stressfractures.pdf. Accessed December 23, 2014.

• High foot arches or flat feet (pes planus)¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,3Kishner S. Physical medicine and rehabilitation for stress fractures. January 27, 2014: Medscape. http://emedicine.medscape.com/article/309106-overview. Accessed December 22, 2014.
• Age, with athletes over 40 and under 18 most at risk³Kishner S. Physical medicine and rehabilitation for stress fractures. January 27, 2014: Medscape. http://emedicine.medscape.com/article/309106-overview. Accessed December 22, 2014.
• Sudden increase in activity level and/or changes in training terrain
• “Weekend warrior syndrome,” in which recreational athletes train hard only one or two days a week while remaining sedentary the rest of the time
• Muscle weakness and/or inflexibility⁵Beck, B. Stress fractures. American College of Sports Medicine, Current Comments. https://www.acsm.org/docs/current-comments/stressfractures.pdf. Accessed December 23, 2014.
• Prior history of stress fracture¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,5Beck, B. Stress fractures. American College of Sports Medicine, Current Comments. https://www.acsm.org/docs/current-comments/stressfractures.pdf. Accessed December 23, 2014.
• Dietary factors, including low calcium intake, low protein intake, and/or high caffeine intake¹Wilder R, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 23 (2004) 55-81.^,6Bennell K et al. Stress fractures. In: Wilder et al. Running Medicine, Second Edition. Monterey, CA: Healthy Learning, 2014. 388-419.
• Prolonged use of oral corticosteroids or other drugs that can decrease bone density⁷American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine. Stress fractures of the foot and ankle. July 2009: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=A00379. Accessed December 22, 2014.

Common types of stress fracture, by sport

Playing different sports put athletes at risk for different types of stress fractures. Some of the stress fractures typically associated with common athletic activities are as follows²Martinez, JM. Stress fractures. May 23, 2013: Medscape. http://emedicine.medscape.com/article/1270244-overview. Accessed December 23, 2014.:

Athletes or other persons with one or more of the above risk factors experiencing nagging pain or weakness during activity and/or at rest are encouraged to consult their doctors, who can either diagnose or rule out a stress fracture.