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Due to their rigid structure, bones possess a natural capacity to withstand a degree of strain. However,
prolonged pressure on the bones may cause them to lose their elasticity and lead to minor stress or hairline
fractures. While these injuries are less severe than complete fractures, they can still cause pain and
discomfort if left untreated. Early recognition and appropriate management of this condition can help prevent
further damage and ensure a full recovery.
By Arete Orthopaedic Centre
Medically Reviewed by Dr Wang Lushun
What Is a Hairline (Stress) Fracture?
Hairline fractures, or stress fractures, are a common sports injury where tiny cracks appear within a bone due
to repetitive force or overuse. Unlike acute fractures which result from a single severe trauma, a hairline
fracture can develop gradually over time, making them easily missed by standard imaging techniques like X-rays.
This condition is commonly seen in athletes and individuals who participate in activities involving high-impact
footwork, such as running and jumping.
The most common sites for hairline fractures are the weight-bearing bones of the lower leg and foot. These
include the tibia (shinbone), heel (calcaneus), metatarsal bones (five long and narrow bones connecting the
midfoot to the toes), fibula (the smaller bone running parallel to the tibia), talus (ankle bone), and navicular
(the bone on the top of the midfoot).
What Are the Types of Hairline (Stress) Fracture?
Hairline fractures can be classified into two types, namely:
Fatigue Fracture
:
This type occurs when normal bones sustain excessive strain, which is common among athletes who abruptly increase the intensity or duration of their training sessions.
Insufficiency Fracture
This type of fracture, typically associated with older individuals suffering osteoporosis, occurs when bones weaken and break even under minimal force.
What Causes a Hairline (Stress) Fracture?
The leading cause of hairline fractures is repetitive stress or overuse of the bone. They may also develop due
to increased duration or intensity of physical activity. The bones adapt gradually to increased forces through
remodelling. In this process, old bone tissue is broken down (resorption) and replaced with new tissue. However,
when the breakdown of the bone surpasses the formation of the new bone, the risk of developing a hairline
fracture rises significantly.
Signs & Symptoms of a Hairline (Stress) Fracture
The symptoms of a hairline fracture can be subtle and may develop gradually. Some common telling signs of hairline fractures include:
Localised Pain: The most common symptom is mild to moderate pain that becomes more pronounced during weight-bearing activities and subsides when resting.
Swelling: The affected area may be slightly swollen and is sometimes accompanied by redness or bruising.
Tenderness: Touching the site of the fracture may be painful or cause sensitivity.
Limited Range of Motion: A hairline fracture makes it challenging to support weight or move the affected limb, leading to stiffness, muscle weakness, or instability.
Who Is at Risk of Having a Hairline (Stress) Fracture?
While hairline fractures can affect anyone, certain groups are more susceptible to developing these injuries, including:
Athletes participating in high-impact sports, such as running, basketball, tennis, or gymnastics
Individuals with foot issues, such as high arches, rigid arches, or flat feet
Individuals with bone conditions, such as osteoporosis
Women, particularly those with low oestrogen levels
Individuals with previous hairline fractures
Individuals with nutritional deficiencies, particularly those lacking calcium and vitamin D
How Are Hairline (Stress) Fractures Diagnosed?
Diagnosing hairline fractures can sometimes be quite challenging due to their inconspicuous nature. Doctors will perform a physical examination and various imaging techniques to accurately identify them. These include:
Medical History Review and Physical Examination: The doctor will ask about the patient’s symptoms and any recent activities or injuries. The affected area is then inspected for swelling, bruising, or deformity. The doctor will gently palpate the area to locate points of tenderness.
MRI: An MRI scan is a reliable imaging test for detecting hairline fractures. It utilises magnetic fields and radio waves to generate detailed images of bones and soft tissues. This test can also assess the extent, location, and type of hairline fracture in patients.
Bone Scan: A bone scan may be used when other imaging techniques are inconclusive. During the test, a small dose of radioactive material is injected into the vein, which is then absorbed by the bones. This substance then accumulates near the fracture site to identify hairline fractures and other bone abnormalities.
Treatment Options for Hairline (Stress) Fractures
The type of hairline (stress) fracture treatment may vary depending on the location of the fracture and how severe it is. Initially, this injury can be managed with non-surgical options, such as:
Rest: Managing a hairline fracture involves a period of rest and avoiding excessive movements or strenuous activities that could worsen the injury (typically lasting around a month).
Immobilisation: Sometimes, a doctor may recommend crutches to keep pressure off an injured foot or leg. Patients may also wear specialised footwear or use a cast to provide support and protection for the affected area.
Medications: Doctors may prescribe over-the-counter pain relievers, such as ibuprofen or acetaminophen, to help manage discomfort and reduce inflammation.
Physiotherapy: Once the initial pain and swelling subside, gentle muscle-strengthening exercises may be recommended to help improve flexibility and range of motion in the affected area.
If these conservative treatments fail to relieve symptoms, surgery may then be necessary to repair or stabilise the fracture, such as internal fixation. In this procedure, specialised surgical hardware, such as pins, screws, or metal plates, is inserted into the bone to accurately align and secure the bone fragments in place while it heals.
How to Prevent Hairline (Stress) Fractures
The following can help one reduce the likelihood of hairline fractures:
Increase the intensity and duration of physical activities gradually
Get adequate rest between bouts of intense training
Maintain a balanced diet that includes calcium and vitamin D
Use proper technique and form in sports and exercise activities
Wear proper gear and footwear to support and cushion bones
If you suspect you may have a hairline fracture or are experiencing persistent pain during physical activities, consult an orthopaedic surgeon for professional medical advice and comprehensive care for your bone health concerns.
FAQs About Hairline (Stress) Fractures
Can a hairline fracture heal by itself?
A hairline fracture can sometimes heal on its own with sufficient rest and avoiding activities that exert pressure on the affected area. It is vital to follow the doctor's advice on pain management to ensure proper healing and prevent further injury.
Can you still walk with a hairline fracture?
Walking with a hairline fracture is generally not recommended, as this can slow down healing and worsen the injury. Your doctor can provide personalised advice on whether it is safe to continue weight-bearing activities or if rest and immobilisation are necessary.
What happens if a hairline fracture is not treated?
If left untreated, a hairline fracture may worsen and result in a complete bone break, chronic pain, and severe complications like nonunion, a condition in which the bone ends fail to join back properly.
With over 18 years of experience, Dr Wang Lushun focuses on treating sports-related injuries, such as
hairline (stress fractures). His patients include former and current national athletes and sports
professionals, as well as everyday individuals seeking orthopaedic care. Known for his patient-centric
approach, Dr Wang offers tailored treatment programmes using advanced minimally invasive techniques to help
patients restore an active, pain-free lifestyle.
Trusted
Leadership on Orthopaedic Advisory Boards
Skilful
Double Fellowships at Centres of Excellence
Experienced
Senior Consultant with Over 18 Years of Experience
