Stress Fractures | Diagnosis & Treatments

How we diagnose a stress fracture

At Boston Children's Hospital, we know that the first step to treating your child is forming an accurate, timely diagnosis. To diagnose a stress fracture, your child’s Sports Medicine specialist will take a medical history and perform a physical exam on your child.

Your child’s doctor will also get x-rays to look for a fracture. But because children can have stress fractures and damage to their growth plates that can’t be seen on x-rays, the clinician may also use an MRI (magnetic resonance imaging) or CT scan and, rarely, a bone scan to get detailed images of the injury to determine if there’s a stress fracture.

What should I do if my child suffers from a stress fracture?

Boston Children's Hospital's Orthopedic Center provides patients with comprehensive care — including evaluation, diagnosis, consultation, non-surgical therapies, surgery, and follow-up care.

Initial first aid for a stress fracture usually involves “R.I.C.E.” (rest, ice, compression, and elevation), as well as medications to help control pain and swelling:

  • Rest: Make sure your child doesn't exert in any way that involves the injured area; she can use crutches or a cane, if it helps.
  • Ice: Wrap a towel around ice cubes, or use a bag of frozen vegetables, to ice the area at two-hour intervals, for 20 minutes each time.
  • Compression: Wrap a bandage or soft brace (from the drugstore) around her injury.
  • Elevation: The child should remain seated or reclining, with her leg elevated, as much as possible before seeing the doctor.

Treatment options for stress fractures

The primary therapy for most stress fractures is simply to rest the injured foot or leg — restricting weight-bearing actions and all activities that involve stressing the injured area for a period of weeks or months. Your child’s doctor may also recommend a cast or walking boot in order to:

  • relax the stress on the leg
  • protect the leg from further damage
  • force the athlete to rest

For a more severe stress fracture, treatment options may include:

  • temporary use of crutches or a wheelchair
  • physical therapy to stretch and strengthen the injured muscles and tendons
  • surgery (less common, but is sometimes needed)  

How long will it take for my child to recover from a stress fracture?

Children usually heal faster and better than adults. Your child should heal from a stress fracture in a period of weeks or months, depending on the severity of the injury.

Complications from a stress fracture

Complications after proper treatment for a stress fracture are uncommon, but can occur. These can include:

  • failure to respond to treatment or to heal properly
  • vulnerability of the area to re-injury
  • a re-injury resulting in chronic problems 

Should my child return to sports if she has been injured?

If your child’s doctor has cleared her to go back to sports, the many benefits and life lessons she’ll gain from playing greatly outweigh the risks of injury. These benefits include:

  • physical fitness
  • teamwork, competitive prowess, accomplishment
  • improved body composition — less risk of obesity
  • reduced risk of heart disease and diabetes
  • stronger immune system
  • academic fitness — kids who play sports often academically outperform kids who don’t
  • emotional and psychological fitness — improved self-esteem, self-concept, self-confidence, empowerment and perception of competence

What is Boston Children’s doing to encourage injury prevention and safer training?

To support our goal of dramatically reducing overuse injuries in youth sports, members of our team often travel to local and regional schools, youth groups, and sports clubs to teach leg strengthening and other techniques. We also conduct frequent safe training programs and clinics for coaches. Call 617-355-3501 for details. 

Caring for your child

Your child's doctor will give you guidance regarding:

  • how long your child's foot or leg should be rested in order for it to heal
  • tools for getting the injured foot or leg back in shape, such as massage, stretching exercises, and strength training
Most kids with stress fractures can return to sports and regular activities after several weeks or months of rest and healing time. But during the healing period, it's important for everybody in the family to support the young athlete's resolve to rest the healing area, since she may feel disappointed and even a bit depressed at not being able to play her sport.

When to seek medical advice

Consult your child’s doctor if her lower leg is painful or inflamed. Tell the doctor if your child:

  • has been training very hard (usually running or aerobics)
  • has changed her exercise routine
  • has been running on hard surfaces
  • has been running with improper footwear
  • has an eating disorder or has been diagnosed with osteopenia or osteoporosis

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

You probably already have some ideas and questions on your mind, but it can be easy to forget the questions you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot them down ahead of time to make sure that all your concerns have been addressed. You may also suggest to your child that she writes down questions to ask her health care provider, too. Some of the questions you may want to ask include:

  • What has happened to my child’s foot or leg, and why?
  • Is a stress fracture a serious injury? Will it do any permanent damage?
  • What tests will you perform to diagnose my child?
  • What actions might you take after you reach a diagnosis?
  • Will my child be OK if she has a stress fracture?
  • Will there be restrictions on my child’s activities? If so, for how long?
  • What should we do at home?
  • How can we help her understand that she needs to rest the injury?

For teens

Many teens who have stress fractures are not only high-performing, determined athletes, but also high-performing, determined students. If you approach your rest and healing period with that same spirit of determination, you should be back to sports and your active lifestyle within a few weeks or months, depending on how severe your injury was in the first place.

The most important thing you can do to get back into your sport is to give your foot or leg a total rest. But even though you know the importance of rest and recovery, you still could find this to be a tough time. If you feel frustrated, depressed, or angry during this important time, speak to your doctor, parent, or counselor — they’re all on your team, and they all want to help.

For parents

If your teen is like many young athletes who have an overuse injury, she’s not only a high-performing, determined athlete — she’s also a high-performing, determined student. Encourage her to approach her rest and recovery period with the same spirit of determination that she applies to other areas of her life. With patience and perseverance, she’ll probably be back to sports and her active lifestyle within a few weeks or months.

Even though you and your teen know the importance of resting her foot or leg, you both might experience her healing period as a difficult time. Parents who identify with their children’s success can feel frustrated or depressed along with their children, so speak to your doctor or counselor if you need help.

Coping and support

At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's — and your own — hospital experience as pleasant as possible. Our Hale Family Center for Families staff will give you all the information you need regarding:

In particular, we understand that you may have a lot of questions when your child is diagnosed with a stress fracture. Will this affect my child long term? When can she return to sports and weight-bearing activities? Children's can connect you with extensive resources to help you and your family through this stressful time, including:

  • patient education: From the first doctor's appointment to treatment and recovery, our staff will be on hand to walk you through your child's treatment and help answer questions you may have — How long will her recovery take? Will she need home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Children's.
  • parent-to-parent: Want to talk with someone whose child has been treated for stress fractures? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share with you their experience at Children's.
  • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy — representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions — who will listen to you, pray with you and help you observe your own faith practices during your Boston Children's experience.
  • social work: Our clinical social workers have helped many families in your situation. Your Children's social worker can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to dealing with a child's injury, changing family dynamics and financial issues.

Sports Trauma and Overuse Prevention (STOP)

Sports Trauma and Overuse Prevention (STOP) is an organization sponsored by the AAOS and the American Orthopaedic Society for Sports Medicine (AOSSM) that’s dedicated to reducing overuse injuries in kids’ sports.

Co-founded in 2010 by Mininder Kocher, MD, MPH, associate director of Children’s Division of Sports Medicine and an associate professor of orthopaedic surgery at Harvard Medical School, STOP provides resources for athletes, coaches, and parents. It offers a community outreach toolkit, as well as engaging, instructive videos on topics relating to various sports.

Pro athletes on STOP’s Council of Champions are carrying the organization’s prevention message out to the sports-minded public. NFL quarterback and 2008 Heisman Trophy winner Sam Bradford has done prevention interviews on ESPN on behalf of STOP. Other pros on STOP’s Council of Champions include Hank Aaron (baseball), Bo Jackson (baseball and football), Howie Long (football), Bonnie Blair (speed skating), Jack Nicklaus (golf), and John Smoltz (baseball).