Stress Fractures In Female Runners

● Female runners are 3.5 times more likely than men to develop stress fracture with
approximately 13% of female runners developing stress fracture.

● Common Causes:
        ○ Training factors:
                ■ Increase mileage
                ■ Change in training surface: concrete is 10 times more dense than asphalt.
                ■ Starting speed work
        ○ Menstrual Disturbances: Hypoestrogenic state accelerates the process of bone
remodeling leading to weakened areas of within the bone.
        ○ Osteoporosis/Decreased bone density
        ○ Endocrine Factors: Calcium deficiency, Vitamin D dificiency
        ○ “Female Triad”: amenorrhea, decrease bone density, eating disorder.
                ■ amenorrhea can lead to average of 4% decrease in bone density/year.
                ■ exercise induced amenorrhea secondary to energy drain on body and
body attempting to conserve energy.
                ■ Oral contraceptive can help offset this hypoestrogenic state.

● Diagnostic Pearls: Pinpoint tenderness, swelling, positive Hop Test.

● Protocol for returning to running after metatarsal stress fracture (must not have pain at
end of each stage to proceed):
        ○ Walk every other day 30-40 minutes x 1 week
        ○ Running 20 minutes every other day x 1 week
        ○ Running 40 minutes every other day x 1 week

● Problematic Stress Fractures:
        ○ Navicular Stress Fracture: area of hypovascularity at middle ⅓ of bone. If non
displace or incomplete, treat conservatively with 6-8 weeks in NWB cast. 80-
100% go on to union. If displaced or complete, ORIF with bone graft treatment of
choice followed by 6-8 weeks NWB in cast. Return to sport 5-7 months.
        ○ Base Second Metatarsal: Almost exclusive to ballet dancers secondary to high
stress placed on 2nd metatarsal during en point position. Treatment consist of 6-
8 weeks immobilization with cessation of ballet/dance activities
during this time.
        ○ Medial Malleolus
        ○ Sesamoids

● Work up:
        ○ Labs: Calcium, Vitamin D, Thyroid
        ○ Xrays
        ○ MRI/CT scan

Podiatrist - Austin, Center for Foot and Ankle Surgery, 1015 East 32nd Street, Austin, TX, 78705 512-477-8853

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Stress Fractures In Female Runners