Stress fractures in the tibia (shin bone) and foot in female athletes have multiple causes. Female athletes have several risk factors that make them more prone to having a stress fracture than their male counterparts.

  1. Puberty is an important time for bone mineralization. Around 50% of women runners diagnosed with stress fractures have irregular menses compared to 29% of those diagnosed with stress fractures having regular menses. Women achieve a peak bone mass by their early 20’s and bone mass is a strong predictor of long-term risk of osteoporosis.
  2. Nutritional deficiencies contribute to decreased bone mass density. Poor caloric intake needed for the energy required for expenditure seems to be a primary factor that predisposes female athletes for menstrual dysfunctions resulting in detrimental effects to bone health.
  3. Poor fitness also contributes to stress injuries. Rigorous training resumed after significant inactivity or injury can be a cause of a stress fracture. A sedentary lifestyle does not allow for a proper, physically fit foundation to be laid in preparation for sporting activities.
  4. Training errors such as increasing mileage too rapidly can result in a stress fracture.
  5. Decreased biomechanical foot position (flat feet), increased hip angle, and leg length discrepancies can contribute to stress fractures.
  6. Running gait patterns can be affected by muscular fatigue, tightness, or minor injury which could result in placing increased stress on bone structures.
  7. Running on poor surfaces or too much hill running can lead to increased risk of stress fractures.
  8. Improper shoe wear can contribute to developing a stress fracture.

Prevention and awareness are key in being vigilant in dealing with stress fractures in both male and female athletes. It would be ideal for the athlete to have a complete biomechanical screening performed by a physical therapist determining any specific weaknesses or inflexibilities along with determining the proper shoe wear for cross country athletes.

Secondly, coaching staffs being aware of their athletes’ current strength level and understanding exercise progression is vital. Cross training and a core stability/stretching program is pertinent to success against injury.

Thirdly, parents being aware of their child’s nutritional intake is vital. Ideally, good caloric intake involves meals that are balanced with whole grains, fruits, vegetables, and protein. Consult your physician about additional supplements of calcium with vitamin D, copper and magnesium. Caffeine, foods/drinks high in sugar, and foods high in fat should not make up a regular diet plan. Consulting a Nutritional Specialist could be beneficial in providing dietary guidance.