| Risk Factors Associated with the Development of Stress Fractures in Children
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Risk Factors Associated with the Development of Stress Fractures in Children

Risk Factors Associated with the Development of Stress Fractures in Children

Factors Associated with the Development of Stress Fractures in Children

Stress fractures are defined as hairline breaks in bones that are exposed to repeated stress over time. These can be described as small cracks on and in the affected bone. Where normal fractures are caused by a sudden or severe impact, stress fractures occur as a result of accumulated trauma to the involved bone from repeated load-bearing activities such as jumping or running. Stress fractures are therefore more likely to occur in athletes and individuals who are sporty and in those who take part in prolonged physical activities.

The bones that can sustain stress fracture include:

  • Those of the lower leg (tibia and fibula).
  • The feet such as the metatarsals (mid-foot), the phalanges (toes), the naviculars (between the mid-foot and toes), and the calcaneus (heel).

A lot has been said about stress fractures in professional athletes but there isn’t much awareness regarding the occurrence of these fractures in children. This article will address this issue further.

Factors Associated with Stress Fractures in Children

A 2013 study looked at how stress fractures may have a specific risk factor profile. The study used nearly 750 high school pupils who were competitive runners, where there was a near 50/50 split between genders. The following discoveries were made:

  • Females were more likely to sustain stress fractures of their tibias.
  • Males sustained stress fractures involving their metatarsal bones.

The factors associated with an increased risk of sustaining stress fractures seem to be linked to:

  • The number of prior fractures in males.
  • Late menarche (start of menstruation) in females.
  • Having a low body mass index.
  • Participating in activities such as dance and gymnastics.


The signs and symptoms associated with stress fractures may be non-specific, which means that other issues affecting the musculoskeletal system could also present in a similar fashion.

These include:

  • Pain over the affected anatomy that increases with exercise or activity and subsides with rest.
  • Localized tenderness around the involved bone.
  • Complaints of generalized tenderness when touching the area in question.

The biggest issue with making the diagnosis of a stress fracture is that generally X-rays don’t demonstrate any pathology on the initial investigation of the problem but the same investigation repeated after a few weeks may show evidence of a stress fracture.

Special investigations that may confirm the presence of a suspected stress fracture include:

  • Computerized tomography (CT) scans.
  • Magnetic resonance imaging (MRI).
  • 3-phase bone scans.


The golden standard for managing stress fractures involves bed rest. Of course, the time needed for complete recovery will depend on the area involved and the severity of the fracture.

Patients have a plaster cast or walking boot applied to the affected limb for four to eight weeks, but longer periods of up to 16 weeks have been recommended in severe cases.

After the appropriate period of time has passed, patients are allowed to gradually and slowly restart their physical activities, and may continue with their chosen activities if there’s no pain experienced when they are performed.

If conservative therapies are ineffective then surgical intervention may be considered and this may entail the performance of a bone graft to mend the fracture.

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