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Stress fracture: When the bone breaks smoothly.

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Dr. St├ęphane Cascua, Medicine and Sports Traumatology.

Your bones can fracture without shock! Running, jumping sometimes enough! It is the stress fracture. How to recognize it How to treat? And especially how to avoid it?

Each receipt jump or stride, your bone is impacted. He is a victim of microscopic cracks. Between workouts, if you give him time, if you bring him the necessary food, it will rebuild. It will even recover louder, as if to take on next constraints. But beware, if the conditions required for repair are not met, if your workouts are too hard or too close, cracks will accumulate, meet and form a real break!

Stress fracture: how to recognize it?

The runner suffers mostly from his shin. A force to compress the inside of her leg, her bone structure cup. He feels pain on the bone just below the calf. It accentuates the kilometers. It does not take long to prevent it from running and then interfere in daily life. Well located, it differs from the "shin" that spans several centimeters. This last lesion corresponds to a shear between the membrane surrounding the bone and the muscle insertion. Less debilitating, it does not impose the automatic discontinuation of the race.

The stress fracture is very fine, "like a hair on a china plate." During the first weeks after the pain, can not see anything on x-ray. It was only after a month that visualizes the bone callus. To enable early diagnosis, scintigraphy is often proposed. To view the fractured zone is injected into the veins a product that attaches where the bone trying to repair. MRI is even better. She further described the fracture or can correct diagnosis by analyzing other tissues.


Sports and physicians must be vigilant. A painful bone in a stressed area is always suspect of stress fracture! The heel bone may break insidiously. Classically, this damage occurs in the military who are marking time during parades or walk long hours with rigid soles. In athletes, the frail fibula located next to the tibia may be concerned. Bone sticks leading to the toes, metatarsals, accumulating twists at the place of the process, also eventually break. In the marathon, even large bones such as the femur or pelvis can break insidiously. The upper limb and trunk are not spared. An avid tennis player is sometimes the victim of a radius of the stress fracture. A golfer swings chaining even manages to break the ribs!

Stress fracture: how to avoid it?

Pace mechanics

When you increase your mileage when you change your workout, you impose on your bones new constraints. Prior to rebuild stronger, they become brittle. The rapid destruction period lasts 14 days. During the 3-4 months, it gradually becomes denser and slowly refines its architecture ... it is still very strong! Caution and progressiveness are required. Although already run 2 to 3 times per week, 3 months are required to prepare a marathon. Feel free to include cycling workouts, swimming or cardio. These sessions are less aggressive for your bones and improve your endurance In order to limit the stress on the inner side of the tibia, your foot should not excessively rock at its support hold. Quality shoes, not too worn and especially suited your stride are indispensable. Sometimes insoles specially designed for sport will prove necessary.

Target intensities

The bone disintegrates and abandon its calcium when the environment is acidic. When you are out of breath you produce lactic acid. Mechanically but also chemically, caution is required in programming quick sessions. During the first months of preparation, the split should be avoided. It is better to teach your body to recycle lactic acid. The said training the "threshold" are particularly suitable. They consist, after heating, to keep 15 to 30 minutes "to limit the shortness of breath". During the following weeks, the working power is ideally effected by chaining 30 seconds "fast" 30 seconds "slow". Under these conditions, the short accelerations are quickly followed by recovery and lactic acid does not accumulate too.

Eat, drink!

Vitamin D facilitates intestinal absorption of calcium and its penetration into the bone. We found mainly in fatty fish: tuna, salmon, sardines, mackerel and herring. You should eat at least 3 times a week.

Calcium binds to the fibrous network of the bone and stiffens in the manner of cement surrounding the rods of steel reinforced concrete. Conventionally there are calcium, in yoghurt, cheese or milk. It is advisable to consume 3 dairy products per day. If you do not like or tolerate these foods difficult, complementary solutions exist. Some mineral waters contain calcium in a large quantity, in the case of Hepar, Contrex and Vittel. Studies show that calcium is absorbed properly. Drink at least 6-8 large glasses a day. Finally, fruits and vegetables contain calcium. Do not hesitate to go beyond the instructions, eat more fruits and vegetables 5 a day!

To fight against the acidity of the body disintegrates bone structure, diet is essential. Despite their flavors, fruits and vegetables are always processed by neutralizing substances. The rich mineral waters bicarbonate as Vichy or Baboit are recommended after the sessions have caused a sharp slowdown. Conversely, sweets and more sodas acidify the body ... and scours the bone! Red meat is acid. Also, eat-in maximum 3 to 4 times a week. It is the same hard cheese to cooked pasta, which he should not be abused despite their calcium content.


Sex hormones stimulate bone construction. They come to miss the bone weakens. Menopause is the usual circumstance to the origin of osteoporosis. But the sporting overwork also reduces the secretion of sex hormones. It is as if the body had to devote all his energy to physical activity at the expense of procreation. This is true for men as for women! In the latter, this phenomenon is known as it is manifested by irregular menstrual cycles or stopping rules. In addition, it is often associated with great emaciation aggravating bone degradation. Indeed, as the ovaries, women's fat cells are involved in the secretion of sex hormones. Decidedly, excessive sport and inadequate nutrition contribute fractures of tiredness!

This is a real break!

If preventive advice comes too late, follow the instructions of your doctor! Know that patience suitable nutritional intake, lack of pain, stress and fitness progressiveness are the key points of the treatment.

Wait ...

The bone consolidation time is 3 months! This is true for fractures by accident! This is true for fatigue fractures! Three to four months is the minimum time that requires your shin to cash without flinching running and jumping!

Eat, drink, fill ...

Nutritional strategies to reduce the risk of stress fracture are now unavoidable ... In addition, vitamin D is also produced by our body through sunlight and studies show that, in our latitudes, the majority of the hungry population. Your doctor will probably prescribe. It is the same calcium if it detects insufficient food intake. There are also supplements to fight against acidity. Some therapists also offer the 'calcitonin' a hormone stimulating bone building.

Avoid pain

The "rule of non-pain" is a good criterion to guide your treatment and your activities. If you have trouble walking, a few days without support are needed. One may even add a long leg splint Velcro, comparable to that used for the rolled ankles. On resumption of the march, moderation is required and the soles are welcome. Exceptionally, if the pain does not give, if the callus does not correctly, intervention is necessary. Most often, the surgeon will put in place a nail in the center of the tibia.


With the collaboration of Olivier TRIBUTE, podiatrist sports.

Attention! This is no shock absorbing soles, type "ready to wear" sold in stores. No, they are "haute couture", tailored to your injury and imperfections of your stride. They are made "to measure" by a podiatrist sports. He knows the injuries encountered in sports. It does not use cork or leather. It uses synthetic materials flexibility cleverly distributed, which tolerate sweat and mechanical stress.

In case of stress fracture, the soles reduce the stress on the broken bone. To limit the compression of the internal surface of the tibia when the heel lands on the ground, the podiatrist reduces the rocker heel outwards. For this, it often places the heel a small external terrain. When the foot rolls on the floor, do not block his rocker inwards but to control it. In order not to pull on the surface of the tibia, an arch support is frequently useful. In the jargon of podiatrists, this dynamic control during all phases of support is called "discharge chute."

Inserting too absorbing materials in the sole is not advised. Initially, their softness causes instability of the support from the opposite of the desired control. Later, they are bunched together quickly and become more binding.

In practice, the wearing of the sole is possible in everyday life during the consolidation period. It is essential in the months following the sports recovery. A distance when the fracture is not a bad memory, it is advisable to change them. Now, these new insoles are designed to prevent recurrences while limiting pressure on other structures of the musculoskeletal system. Often the relief is reduced and modified, they are mainly adapted to the aftermath of the rider.


move gradually

If your bone must be relieved to consolidate, it must also readjust gradually to the stresses of everyday life and sport. Schematically, the first month you can keep fit in the pool practicing swimming and aqua jogging. During the second month, add bike. Start cranking then increase the resistance and finally put on the pedals. In the third month after clearance from your doctor, it is possible to reintroduce the race ... in all humility. Walk trottinez ... a few strides and then 3 to 5 minutes ... increase 3 to 5 minutes on each output ... finish your workout by as many bike as you like! A 3 or 4 months of your injury, jogging thirty minutes is often possible.

Doctor St├ęphane CASCUA. - 16 juillet 2010.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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