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Hairline (Stress) Fracture

Medically reviewed by William Morrison, M.D.
— By Mariah Adcox — Updated on April 19,
2023

Symptoms Causes Risk factors

Diagnosis Complications Treatment
Outlook

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A hairline fracture typically results

from injury and can cause swelling
and tenderness. Treatment may
involve applying ice to the affected
area.

A hairline fracture, also known as a stress

fracture, is a small crack or severe bruise
within a bone. This injury is most common in
athletes, especially athletes of sports that
involve running and jumping. People with
osteoporosis can also develop hairline
fractures.

Hairline fractures are often caused by overuse

or repetitive actions when microscopic
damage is done to the bone over time. Not
allowing yourself enough time to heal between
activities is often a factor in the probability of
getting this injury.

The bones of the foot and leg are especially

prone to hairline fractures. These bones
absorb a lot of stress during running and
jumping. Within the foot, the second and third
metatarsals are most commonly affected. This
is because they’re thin bones and the point of
impact when pushing off on your foot in order
to run or jump. It’s also common to experience
a hairline fracture in your:

heel

ankle bones

navicular, a bone on the top of the

midfoot
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What are the symptoms of a

hairline fracture?
The most common symptom of a hairline
fracture is pain. This pain can gradually get
worse over time, especially if you don’t stop
weight-bearing activity. Pain is usually worse
during activity and lessens during rest. Other
symptoms include:

swelling

tenderness

bruising

What causes a hairline fracture?

Most hairline fractures are caused from either
overuse or repetitive activity. An increase in
either the duration or frequency of activity can
result in a hairline fracture. This means that
even if you are used to running, suddenly
increasing either your distance or the number
of times per week you run can cause this
injury.

Another similar cause of a hairline fracture is

changing the type of exercise you do. For
example, if you’re an excellent swimmer, it’s
still possible to sustain an injury from suddenly
engaging in another intense activity like
running, no matter how good of shape you
may be in.

Bones adapt to increased forces put on them

through various activities, where new bones
form to replace old bone. This process is
called remodeling. When the breakdown
happens more rapidly than new bone can
form, you increase your likelihood of a hairline
fracture.
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Who’s most at risk for

developing a hairline fracture?
There are also a number of risk factors that
increase your chances of getting a hairline
fracture:

Certain sports: Participants in high-

impact sports, such as track and field,
basketball, tennis, dance, ballet, long-
distance runners, and gymnastics,
increase their chances of getting a
hairline fracture.

Sex: Women, especially women with

absent menstrual periods, are at
increased risk of hairline fractures. In fact,
female athletes may be at a greater risk
because of a condition called the “female
athlete triad.” This is where extreme
dieting and exercise may result in eating
disorders, menstrual dysfunction, and
premature osteoporosis. As this
develops, so does a female athlete’s
chance of injury.

Foot problems: Problematic footwear can

cause injuries. So can high arches, rigid
arches, or flat feet.

Weakened bones: Conditions such as

osteoporosis, or medications that affect
bone density and strength, can cause
hairline fractures even when performing
normal, daily activities.

Previous hairline fractures: Having one

hairline fracture increases your chances
of having another.

Lack of nutrients: Lack of vitamin D or

calcium can make your bones more
susceptible to fracture. People with
eating disorders are also at risk for this
reason. Additionally, there can be a
greater risk of this injury in the winter
months when you may not be getting
enough vitamin D.

Improper technique: Blisters, bunions,

and tendonitis can affect how you run,
altering which bones are impacted by
certain activities.

Change in surface: Changes in playing

surfaces can cause undue stress to the
bones of the feet and legs. For example,
a tennis player moving from a grass court
to a hard court may develop injuries.

Improper equipment: Poor running

shoes can contribute to your likelihood of
getting a hairline fracture.

How’s a hairline fracture

diagnosed?
If you believe you have a hairline fracture, it’s
important to seek treatment from your doctor
as soon as possible.

Your doctor will ask about your medical history

and general health. They’ll also ask questions
about your diet, medications, and other risk
factors. Then, they may perform several
exams, including:

Physical examination: Your doctor will

inspect the painful area. They’ll probably
apply gentle pressure to see if it causes
pain. Pain in response to pressure is
often the key for your doctor to diagnose
a hairline fracture.

MRI: The best imaging test for

determining hairline fractures is an MRI.
This test uses magnets and radio waves
to provide images of your bones. An MRI
will determine a fracture before an X-ray
can. It’ll do a better job of determining
the type of fracture as well.

X-ray: Hairline fractures often aren’t

visible on X-rays immediately after the
injury. The fracture may become visible a
few weeks after the injury takes place,
when a callus has formed around the
healing area.

Bone scan: A bone scan involves

receiving a small dose of radioactive
material through a vein. This substance
accumulates in areas where bones are
repairing. But because this test will
indicate an increased blood supply to a
particular area, it won’t specifically prove
there’s a hairline fracture. It’s suggestive
but not diagnostic of a hairline fracture,
as other conditions can cause an
abnormal bone scan.

If you need help finding a primary care doctor,

then check out our FindCare tool here.
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Can other conditions develop if

hairline fractures aren’t treated?
Ignoring the pain caused by a hairline fracture
can actually result in the bone breaking
completely. Complete breaks will take longer
to heal and involve more complicated
treatments. It’s important to seek out help from
your doctor and treat a hairline fracture as
soon as possible.

How are hairline fractures

treated?
If you suspect you have a hairline fracture,
there are a number of first aid treatments you
can perform before you go to the doctor.

Home treatments

Follow the RICE method:

rest

ice

compression

elevation

Nonsteroidal anti-inflammatory drugs (NSAIDs)

such as ibuprofen (Advil, Motrin) and aspirin
(Bayer) can help with pain and swelling.

It’s important to seek further treatment from

your doctor if the pain becomes severe or
doesn’t get better with rest. How your doctor
chooses to treat you will depend on both the
severity and location of your injury.

Purchase NSAIDs here.

Medical treatments

Your doctor may recommend that you use

crutches to keep weight off an injured foot or
leg. You can also wear protective footwear or
a cast.

Because it usually takes up to six to eight

weeks to completely heal from a hairline
fracture, it’s important to modify your activities
during that time. Cycling and swimming are
great alternatives to more high-impact
exercises.

Some hairline fractures will require surgery,

where bones are supported by the addition of
a type of fastener using pins or screws to hold
bones together during the healing process.

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What’s the outlook for someone

with a hairline fracture?
It’s important to avoid high-impact activities
during the healing process. Returning to high-
impact activities — especially the one that
caused the injury in the first place — won’t only
delay healing but increase the risk of a
complete fracture in the bone.

Your doctor may advise taking another X-ray

to ensure healing before allowing you to return
to your previous activities. Even after the
hairline fracture is healed, it’s important to
gradually return to exercise.

In rare instances, hairline fractures won’t heal

properly. This results in chronic, long-term
pain. It’s important to talk to your doctor to
prevent pain and worsening injuries.
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Last medically reviewed on September 19, 2017

How we reviewed this article:

SOURCES HISTORY

Our experts continually monitor the health and

wellness space, and we update our articles
when new information becomes available.
Current Version

Apr 19, 2023

Written By
mariah-adcox-83612-user

Edited By
Judy Lee

Sep 19, 2017

Medically Reviewed By
William Morrison, MD

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