Tibial Stress Fractures

A tibial stress fracture is a fortunately uncommon cause of leg pain in athletes, especially running athletes or those who participate in repetitive landing from a jump, such as gymnastics. Typically athletes complain of pain that increases over a period of time, usually in response to increased stress. A common story is a runner who is increasing his or her training over a short period of time. Often he or she starts having pain that comes on with a run, and over the next few days or weeks, the pain comes on sooner and takes longer to go away after stopping the run. After a while, pain persists with activities of daily living, such as walking.

Tibial stress fracture
Note the increased uptake in the mid-tibia on the bone scan of this young athlete.

In the office, the physician will perform a history and physical examination. Examination of a tibial stress fracture will often reveal a more localized pain than shin splints, although this finding is not always true. Usually tightness of the calf muscles and numbness and tingling are absent. X-rays will often show a tibial stress fracture if symptoms have been present long enough. Physicians often refer to the x-ray findings as “the dreaded black line,” which is a break in the cortex of the bone but no fracture all the way through the bone or any displacement of the fracture. If the symptoms are fairly recent, x-rays might not show a stress fracture, so further testing, such as bone scans or MRI’s, are often used. Tibial Stress Fractures and Athletes.

Treatment of a tibial stress fracture can be either surgical or nonsurgical. This is potentially a worrisome diagnosis, as continued stress on a tibial stress fracture could lead to a complete fracture and require surgical treatment. If nonsurgical treatment is elected, many physicians recommend complete nonweightbearing and use of a cast or walking boot. At a minimum, absolute refrain from the offending activities and sports is mandatory. If the fracture is not healing, we often consider surgical treatment. Tibial stress fractures, especially in the setting of delayed healing, involves placement of a nail down the center of the bone with or without additional bone grafting to try to stimulate healing of the bone.

The Dr. David Geier ShowSurgery for a tibial stress fracture?

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Recovery from a tibial stress fracture is lengthy whether or not surgery is performed. Usually physicians will not let the patient return to sports or exercise such as running until the fracture has completely healed. That process can often take three to four months. At that point, activities are gradually introduced. The time to return to sports is lengthy, but if the fracture heals uneventfully, return to full participation with no limitations is often seen.

If you have specific questions about tibial stress fractures, please Ask Dr. Geier directly.

28 Responses to Tibial Stress Fractures

  1. hie, I met an road accident about an 4months ago.i broke my right tibia..compound fracture doctor planted a metal rod and two nail inside my leg…now I m walking without crutches. .can I play badminton after a few months..

    • Patients can usually return to sports and exercise after surgery for a tibia fracture when the bone has completely healed and the patient has regained full motion, strength and ability.

  2. I’ve been diagnosed with bilateral tibial stress fracture. My left leg is the one that hurts. My ortho doctor didn’t put me in a boot or cast. Just said no running. Is this protocol?

    • The treatment necessary for a tibial stress fracture can vary depending on the specific location of the fracture. Some stress fractures need periods of complete nonweightbearing, while others can potentially be treated by just limiting repetitive impact.

      • They don’t hurt anymore. When I’m resting, my shins feel like I rubbed icee cool or have a heat pad on them. Is this normal?

  3. I have had medial tibial stress syndrome for almost 3 years now, and the last time I was cleared for a stress fracture/reaction was last year. At first my left shin would only hurt when I was jumping or running. Now, it still hurts running and jumping but also after activity, the spot on my shin aches and it barely hurts to walk. I am going to get an MRI tomorrow, but how likely is it that I have a stress fracture?

    • I really can’t say or predict without being involved in your care. If a patient’s pain is increasing, coming on earlier or taking longer to go away, or is more pinpoint in location, then a stress fracture could be more likely.

  4. I have a tibial stress fracture from running and was told to use crutches for three weeks. In general, is this really necessary once the pain has subsided (as it has, in my case). Feels silly to use crutches when nothing hurts.

  5. Hi, i have a tibia plateau fracture that’ shattered my knee a little over a week ago. I had surgery and had a bunch of screws put in. I am now in recovery and just lay all day with my leg elevated besides when I have to use the restroom. Only concern is when I do go use the restroom or if I flex my foot my calf muscle is extremely sore. Should I be worried or isn’t just post op pain? It’s also painful to massage the calf even when not flexed, but when laying down there is no pain.

    • Laura, I can’t really give you specific information or advice, but you should run your concerns by your orthopaedic surgeon. It is possible for a patient to develop a blood clot in her leg after surgery, but she can also have pain related to the fracture and surgery.

  6. I have been experiencing pain for 5 weeks in tibia region and have ceased running during that time. I had been running through discomfort for 2 weeks prior to that. Over the resting time I felt as if the pain was getting better (still do feel it though, even just when walking) and I put off seeing a doctor until mid week 4 and had an MRI done at the 5 week mark, which showed a grade 1 stress injury. I am wondering, if I had the MRI done 3 weeks ago, when the pain was at its worst, is it possible the MRI would have shown a more severe injury and that the injury had healed down over the weeks?

    • I can’t say in your case, but if a patient has a stress fracture, an MRI later in the process could show less edema and a resolution of the fracture line.

  7. i m having pain both legs which is localised in my tibial bone .it increasd in prolonged standing walking and i can not jump.pain is pinpointing.whn touched at that point pain is unbearable.i m not athlete but why i got stress fracture and wht to do in my case.
    x ray n ct scan shows line on lower third of tibia

    • I can’t say without seeing it, but if a patient has a tibial stress fracture, then I would recommend seeing an orthopedic surgeon and following his or her advice for treatment.

  8. I got a stress fracture in my left tibia in Dec of 2012 while exercising. Was told it was shin splint so continued to run on treadmill for another month before insisting on X-ray which confirmed the diagnosis. Was initially treated by placing me on crutches x 12 weeks completely non weight bearing. During this time did bone density, took me off all ibuprofen, etc because of slow healing. Fast forward 2 years and I am currently still in a walking boot and on my third ortho dr and X-ray shows non healing. For a while they found I was vitamin d deficient but with supplements was able to get that corrected. I am only 40 yrs old so too young to have a fractured leg the rest of my life. All doctors have only tried crutches, PT, Walking boot but no body can find out why not healing nor do they seem to care enough to try to figure it out. Does anyone have any suggestions or know what I should try next? Permanent limp and at my wits end as I am a full time working nurse and mom of two young children. Please help!!!!

    • I don’t know if it is an option in your case, but surgery can occasionally help a nonunion of a tibial stress fracture heal.

    • My wife is going on 30 weeks. ..2 mri countless blood work, multiple xrays, she’s 36….very active. Crutches, walking boot, nothing is working. ….what do we do? She isn’t healing and the Dr is saying she may just have to deal with a stress fracture the rest of her life? Seriously?

  9. Hello Dr David I have a tibial plateau stress fracture from running in Aug/14 and was put on hinged brace, non weight bearing with use of crutches for 8 weeks, which I did follow exactly as recommended by my doctor. I had 3 MRIs done since Sep but still shows that fracture is present with a delay healing. My doctor has suggested bone stimulator device OL 1000sc which is very expensive but I was very fortunate to have its cost covered by my insurance and just started the treatment. What i would like to ask how effective this bone stimulator treatment can be? There are not much info about it. Pain has subsided considerably and I am off crutches/brace and walking normally with somewhat discomfort on knee region. Also what consequences/sequela that non healing stress fractures can bring to person if not dealt in the right ways for the short and long term. Thanks

    • Research shows conflicting results for bone stimulators, but they can occasionally be worth trying for some patients. The consequence of a stress fracture that doesn’t heal is continued pain or the fracture becoming a complete and even displaced fracture.

      • Ok. Here is my concern If a non healing tibia stress fracture goes on for a prolong period of time, can it causes the bone cells to die and never regenerate themselves again even with surgery? Thanks

  10. I am a female in the army. I was in a unit that only rucked up mountains and ran. I had shin pain and calf tightness/weakness to the point where I had a hard time walking. Long story short, I was told to continue running on my injuries. I have not ran in over a year and have shin pain everyday, mostly at rest, but with walking at times. What are the long term consequences for running on his injury?

    • Vanessa, it is really hard to know the consequences without knowing the cause of the problem. You might see an orthopaedic surgeon to find out if you have CECS, a stress fracture or some other problem.

  11. I had a stress fracture so the doctor gave me a boot but the boot wasn’t helping so I asked if the doctor could put me in a cast, so the doctor put me in cast for 6 weeks and it was fine for a few weeks but it started hurting evertime I run…that was summer 2013. Because I didn’t wanna give up the sport(soccer) I did not tell my doctor about it and I have been playing with it for a year and half. Should I go and tell him and if I do, does that restrain me from playing if so for how long approximately. How long does it take to get back after surgical treatment?

    • Surgery for a tibial stress fracture can take 4-6 months or more for return to sports. Return generally depends on full healing of the fracture, surgery or otherwise.

  12. So I’ve had a stress fracture for over 3 years now. The first time I was placed in a boot for 2 months and was limited to non-weighted activities. I come back to play my sport basketball and everything is find. Than a week or two later my leg starts hurting again. I take pain pills to tolerate the pain to play. I have a big lump on my leg. I went to the doctor and was told that my stress fracture is back. He recommend that I do shockwaved instead of surgery. I’m in Germany playing basketball and the shockwave involves me staying here another 2 months. Which should I decide to do? In college I had an bone stimulus that I wore for 1 hour each day and it didnt help. So which should I decide to do?

    • Demetrius, I cannot give you specific medical advice on this website. Generally surgery is at least an option for patients with nonunion of a tibial stress fracture. Your orthopaedic surgeon could better advise you as to the options and whether surgery could be necessary.

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