The primary symptom of a stress fracture is pain and tenderness at the fracture site, though some stress fractures produce little to no symptoms at all until they progress to a more serious injury, such as a displaced fracture.1
Symptoms of stress fracture include, but are not limited to:
Nagging, aching pain that is felt deep within the foot, toe, ankle, shin, hip, or arm. The exact source of the pain may be difficult to pinpoint, such as a general ache in the entire foot or lower leg.1
Dull pain that disappears with rest but resumes with activity or weight-bearing. For example, pain in the foot or ankle that appears when the foot strikes the ground while running or dancing, but disappears after the exercise sessions end, or pain in the elbow or shoulder that only occurs when throwing or receiving a ball. The pain may not start at the beginning of the exercise, but may develop at the same point during the activity.
A general feeling of weakness in a foot, ankle, or limb, with or without pain. A runner may suddenly be unable to match previous speeds or distance without feeling exhausted or having a leg give out, though it is less likely that this happens without some at least some pain.1
Tenderness and swelling. The soft tissue around a stress fracture may become swollen and tender to the touch. Bruising may also be present, though this is rare for most stress fractures until they become severe.1-3
Localized pain at night. Pain in a certain area, such as the foot, ankle, or hip that appears in the evening is often associated with stress fractures, even if the pain is not debilitating during sports activities.2
Pain that does not improve with rest or RICE protocol. Pain that resumes or remains constant despite taking time off to rest and/or using the RICE (rest, ice, compression, and elevation) protocol may be due to a stress fracture or other causes.2
Learn more: The P.R.I.C.E. Protocol Principles
Pain in the back or sides. Nagging pain in the trunk can sometimes be an indicator of stress fractures in the rib cage and/or sternum, which can occur in athletes who participate in sports such as rowing, tennis, or baseball.
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Pain that progressively worsens over time. Pain that starts out as a dull ache which once only appeared during sports activity but has become constant and debilitating may be an indication of a developing stress fracture. Another concern is when a young, healthy patient requires crutches because of lower-extremity pain that developed gradually, as this can be a sign of a stress fracture.
Pain that appears shortly after a change in activity. Nagging pain that appears within 7 to 10 days of a significant increase in strenuous activity—such as enrolling in military boot camp—is frequently associated with stress fractures.
Because stress fractures often only improve with rest, any athlete who experiences symptoms that indicate a possible stress fracture is advised to take a break from sports activity and see a doctor trained in sports medicine for an accurate diagnosis and treatment plan.