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.

63 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?

      • I do gymnastics 5 days a week, 3 hits and 45 minutes every time sometimes 4 hours. I’m a kid and my knees go in when I have my feet together like they even touch!!!! And every practice they hurt like house falling on them hurt, and when I’m just laying down they throb, and pound, and hurt!!! Are they broken?

    • Check your diet. I would recommend paleo diet. Get off of all grains and sugars and hardly any fruit. Increase good fats like coconut oil, grass-fed butter, olive oil

  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.

  13. How often do you see abnormal reactions in the bone after a rod is surgically placed? I had an IM rod put in a year ago for a stress fracture and due to continued pain had another bone scan that showed significant brightness over the distal and proximal screw sites and general brightness throughout the shaft compared to my good leg.

    • You would have to ask a neurologist for sure, but I’d think that if a NCV test showed normal conduction through the nerve, then it suggests no nerve damage.

  14. I believe I have a multiple small stress fractures in both of my shins. There is a slight constant pain which made me seriously consider it. I am going to West Point in one month and have laid off of weight bearing and other shin related exercises for about a week now. I have been swimming and doing upper body workouts, those are fine right? Also, I have been wondering if heat (bringing blood to the surface) or ice therapy would help. If not is there anything that would help accelerate healing? I am also taking vitamins and keeping up on calcium intake. Thanks Dr. David!

  15. I play volleyball and fractured my tibia plateau while doing so. It was non-surgical and I was on crutches for eight weeks with no brace. The fracture was also pretty small, and only showed up on an MRI. I am now walking on it entirely and it’s pain-free, but approximately how long might it take for me to go back to going to practices?

    • Eleanor, that’s a great question, although it is hard to say. I would definitely ask your doctor. Generally the fracture must heal completely, and then a patient slowly works through a jogging program and return-to-sports progression. It can take 4-6 weeks after the doctor allows it.

  16. I am a runner and was diagnosed with a distal tibial stress fracture in my left leg last year. I ran with pain throughout the summer thinking I had a case of severe shin splints before finally seeing an orthopaedists and having an MRI done. I was put on crutches and advised to be completely non-weightbearing for 3 months. That wasn’t feasible for my line of work (I’m a personal trainer) so I was given the okay to have limited time away from the crutches as needed for work only and was on the crutches at all other times. The pain in my shin did go away and I returned to running (very gradually!) after the 3rd month. Now that my running is picking up again for the summer I’ve started experiencing the SAME pain. I’m not happy. My Ortho said if the pain returned we would be looking at putting a rod in the bone. This sounds terrifying to me! I’m concerned that it will put an end to my running completely and I’m avoiding making that appointment to see him again for this reason. What is the recovery period for this type of surgery? Is the rod permanently placed? Will it affect my running? Scared but also don’t want to further damage my bone by running on it!

    • If surgery is needed for a tibial stress fracture, it is usually a rod placed down the bone plus bone graft added to the fracture site to help it heal. Recovery can take 3-6 months. Good luck! I know that is scary!

  17. i was diagnosed with a tibia stres fracture and had put on a cast for 6 weeks now after taking it off the xray shows the stress fracture is still not fully healed! there is no pain! i am a soccer player and i realy need tu play! i am helpless what should i doo? and i want to know how long it takes to completly heal stress fracture without a surgery!

  18. Hi, it’s been almost six weeks since i smacked my knee and was diagnosed with 1mm depressed, non-displace TP Fx. I did NWB completely for 2 weeks, RICE, then it felt fine and started walking again regularly 3 weeks in. I’m wondering if this was a bad idea, it feels OK but gets stiff and sore at the end of the day. I want to return to running/cycling ASAP but now worried I might have worsened the fracture after doing research research on this.

    • Nonsurgical treatment for a nondisplaced tibial plateau can be appropriate if it can heal in the appropriate position.

  19. Hello,

    I was was diagnosed with bilateral tibia plateau stress fractures about two months ago. Since then I have done several things to help myself recover, sitting, non weight bearing for a month, crutches, wheel chair etc… I was recently told by my doctors to start putting weight back on my knees by using crutches or a scooter and also by walking around my house. Now, my question is; are my knees and shins supposed to hurt when using crutches and walking around the house? I know I will have some pain, since I have not been using my legs, but my knees, shins and ankles all ache. Is this normal?

    • Generally patients don’t have much pain, but I suppose that increased stress from new weightbearing can cause a patient to have discomfort.

  20. I began running in February after being mostly sedentary. I thought that I had shin splints, but the pain didn’t go away. I stopped running in April, and then accidentally slammed the shin that was hurting into a trailer hitch on our truck. It didn’t hurt to walk, but it did hurt going up stairs. I finally went to the doctor a week ago, and there was a visible fracture on my tibia. The doctor said that it is 50% through the bone. I’m in a boot for 6 weeks with crutches, but I was told that I could put as much weight on the leg as is comfortable. It didn’t hurt to walk before I started wearing the boot, but with the boot, it hurts to walk. Also, I have a Stinging pain at the fracture point sometimes when I am resting it. Is this normal? Should I be concerned?

    • It is hard to say without being involved and seeing the x-rays. Soreness at the fracture site can be common as a patient starts bearing weight, but it is hard to say if it is problematic in your case specifically.

  21. About 14 weeks ago I was diagnosed with a tibial plateau fracture. I’m still at the non weight bearing stage because it is still not healed. At this point, is surgery a better option? To ensure that it’s strong ?

    • If an orthopaedic surgeon determines that a fracture isn’t healing, then surgery to put plates and screws in and possibly add bone graft con be considered. Surgeons often have different opinions in when to abandon non-surgical treatment and proceed with surgery.

  22. Hi, I went to the sports medicine doctor because I had a vague discomfort in the arch of my foot after running 20 miles. I didn’t think it was much to be concerned about but wanted to be cautious because I had a marathon in two weeks. When I went in, the doctor sent me for an MRI, and it turns out that I have a tibial stress fracture. The crazy thing is I have never felt pain in my shin while running and it doesn’t hurt at all. The doctor squeezed the spot where the fracture is showing up and I definitely flinched. But, I am wondering how is it possible that I have a stress fracture that I can’t even feel?

  23. Hi,i have had a tibial stress fracture for about 6 months now and i have tried everything other than surgery to heal it, but ive got nothing. ive went to many doctors about it and i get the different results everytime. Im a 16 year old boy that plays football, basketball, track, and baseball. What i have came to is the fact that im going to have to have surgery on it. The surgery would be the rod in my shin, but ididnt know what i would have after for the 4-6 months of recovery time. Do you know if i would have a boot or if it would be a cast? Or possible anything other than that? I need a reply soon if you could thanks.

    • Generally once the fracture has healed after surgery, the patient doesn’t use a cast or a boot. Often he does wear a boot in the early recovery phase.

  24. Hello, i was training for niece marathon and 5 weeks ago i had pain in the calf and shin i had a mri done and it showed medial stress syndrome stress injury to the proximal diaphysis also grade 1 staring to calf Sunday would be 5 weeks still feel some pain in the local area Do you think i can hurt myself if i run the marathon on sunday??

    • It is possible to aggravate a calf strain and cause further injury. Plus those can be painful injuries to try to train or compete with.

  25. I went to the orthopedist and got an MRI for pain in the upper tibia, outside of the patellar tendon area. Thought it might be patellar tendinitis. The ortho found a small stress fracture and just told me not much to do other than rest and maybe vitamin D. It’s been a month or so and still pain when I press that area. Do you find it odd that he didn’t prescribe crutches? I’m wondering if I’m delaying healing by walking around.

  26. I have a tibia stress fracture that I fought the pain for 5 weeks prior to seeing a podiatrist who confirmed stress fracture via mri and booted me for four weeks. The pain seems to be unchanged and the pinpointed pain area seems to be even higher up by leg.

    I am type 2 diabetic, could my diabetes be preventing me from healing and maybe even contribute to the injury site expanding? Can a fracture lead to any type infection?


    • Diabetics can be slower to heal fractures. Generally they aren’t at risk for infection unless there is an open wound.

  27. My mother suffered frm right tibial plateau hairline fracture around three months back when she was hit by a strong wave on the beach..she was on complete bed rest with cast on her leg ..now her fracture has healed but still she’s unable to walk..she’s getting physiotherapy sessions but she’s hving a really hard time walking she can walk with the help of a stick or walker can easily flex and extend her leg bit wem she tries to walk without any support she’s unable to do it..her ankle hurts as well..y is it so ?

  28. I have a tibial plateau stress fracture. I am on crutches, no weightbearing, I have a j-splint that I wear except to shower and sleep. I am having a burning/stinging sensation on the outside of my knee where the fracture is. Should I be concerned about this. I am 55 and do not want to deal with this the rest of my life.

  29. Hey DR. I have been dealing with a Stress Fracture in my right tibia probably 3 inches above my Medial Malleolus for about 11 months now. I went to a Nurse Practitioner last year in the middle of basketball season as I play high school level. I got an Xray and she said it was just shin splints and i was Cleared. I continued to play for about another month until I could not bare it. I went to my Sports Med. Doc and got a MRI and my leg was on fire. I got booted for six weeks and then I was cleared. Only my leg started to hurt again after a few days. SO I just kept going on for about 3 months then I went back after reading about how a dead space can form. So I got the boot on again and used crutches for 3 weeks out of my 6 in the boot. Now i go to physical therapy but my leg still bothers me when im sitting down in the same spot. i think its muscular pain and not my bone as i think it was musclar pain the second time i had it on but i mistaked it for bone pain. Sometimes my feet go numb and I was thinking maybe compartment syndrome as well. What do you suggest i do.

  30. Hello doc….
    I had an accident on april 2015 on which my tibia and fibula were broken..it was a displaced fracture. Doc inserted ha rod with 2 nail above and 2 below…but there is a small gap remain which are not healing…iAm very worried plzz kindly give me some suggestion..

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