Stress Fractures

Common Symptoms

• Localized pain that builds gradually with activity, initially only during exercise, then increasingly with daily activity
• Tenderness at a specific point on the bone, rather than a diffuse muscle ache
• Swelling over the area in some cases
• Pain that doesn't improve, or worsens, despite rest — a signal that shouldn't be ignored
• A recent increase in training volume, intensity, or a change in surface/footwear preceding symptom onset

Why It Happens

Bone constantly remodels in response to load — this is normal and healthy. A stress fracture develops when repetitive loading outpaces the bone's ability to remodel and strengthen, particularly with rapid increases in training volume or intensity, inadequate recovery, or nutritional/hormonal factors that affect bone density and repair capacity.

Why It Can Become Persistent

Certain stress fracture locations — most notably the proximal fifth metatarsal (the "Jones fracture" zone) and the navicular bone in the foot — have a naturally reduced blood supply, which makes them prone to slow healing or progression to non-union even with appropriate rest, which is part of why these specific locations are treated more cautiously than most stress fractures.

Who Commonly Gets It

Stress fractures are common in runners, military recruits undergoing basic training, and other athletes with a sudden increase in repetitive impact activity. Female athletes with relative energy deficiency are at elevated risk, as are athletes returning from a break who resume training too quickly.

How It Is Usually Diagnosed

Stress fractures aren't always visible on initial X-ray, especially early on — MRI or bone scan is more sensitive and is often used when a stress fracture is suspected but not confirmed on X-ray. Your provider will also assess the specific location, since higher-risk locations (fifth metatarsal, navicular, femoral neck) are managed differently than lower-risk locations.

Traditional Treatment Options

• Activity modification / relative rest: Reducing or temporarily stopping the aggravating impact activity is the foundation of treatment for most stress fractures.
• Protective footwear or a walking boot: Used for some locations to offload the healing bone during daily activity.
• Gradual return-to-activity program: A structured, progressive return to running/impact activity to avoid re-injury.
• Addressing contributing factors: Nutrition, bone density, training load, and biomechanics are often reviewed, particularly for recurrent stress fractures.
• Surgery: Reserved for higher-risk locations (such as the fifth metatarsal) in athletes wanting a faster, more predictable return to sport, or for fractures that progress to non-union.

Why Someone Might Start Looking for Another Option

Athletes, in particular, are often eager to return to training sooner than a standard healing timeline allows, and a stress fracture in a higher-risk location that's healing slowly can be a frustrating, open-ended wait — which is when some athletes and their care teams look into options that might support healing more directly.

Where Shockwave Therapy May Fit

Shockwave therapy has published research specifically comparing it with surgical fixation for non-union fifth metatarsal stress fractures in soccer players, and broader sports-medicine literature has examined its use across several stress-fracture-prone locations as part of a comprehensive return-to-play approach, generally alongside — not instead of — appropriate activity modification.

How Shockwave Treatment Works for This Area

If shockwave therapy is judged appropriate for your specific stress fracture (typically for slow-healing or non-union stress fractures, not as a substitute for standard activity modification in routine, uncomplicated stress fractures), focused shockwaves are directed at the fracture site to support the bone's healing response.

What the Treatment Feels Like

Treatment directly over a stress fracture site can be tender; your provider will discuss what to expect based on the specific bone and stage of healing involved.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Newly diagnosed, uncomplicated stress fractures, which typically heal well with standard activity modification alone
• People who have not yet had imaging to confirm the diagnosis and location
• Suspected complete (displaced) fracture, which needs orthopedic evaluation rather than shockwave therapy
• Active infection, open wounds, or certain conditions at the treatment site, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.