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  • Writer's pictureSachin Bhat

Bone Stress Injuries

Early identification of bone stress injuries, particularly in the lower limb, is of utmost importance to effective management of these conditions. They need to be identified early so appropriate management strategies can be put in place to prevent further progression, and to help identify any contributing factors to this (including medical conditions).

Approximately 10% of all sporting injuries are bone stress injuries, with 80-95% of these coming from the lower limbs.

Tibia 23-49%

Tarsals 25%

Navicular 17%

Metatarsals 8-16%

Femur 6%


These can further be categorized into HIGH and LOW risk stress fractures/injuries. Bones that are subject to high TENSILE forces and have POORER blood supply fall into the high risk category. These are injuries that tend to heal more poorly and have worse outcomes in the short and long term. Bones that are subject to COMPRESSIVE forces and have BETTER blood supply are considered low risk. These are injuries that tend to heal and improve well when managed appropriately.


Examples of low risk bone stress injuries:

-          Posteromedial tibia

-          Lateral malleolus

-          Calcaneus

-          Cuboid

-          Cuneiforms

-          2nd and 3rd metatarsals


Examples of high risk bone stress injuries:

-          Anterior tibial cortex

-          Medial malleolus

-          Talus

-          Navicular

-          2nd base metatarsal

-          5th base metatarsal

-          Sesamoids


If you are concerned you have bony pain, ensure to reach out to have a thorough assessment of your pain to ensure you manage your pain safely.

By Sachin Bhatt


Coslick, A.M., Lestersmith, D., Chiang, C.C. et al. Lower Extremity Bone Stress Injuries in Athletes: an Update on Current Guidelines. Curr Phys Med Rehabil Rep (2024).

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