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Time to return to sport by stress fracture radiographic findings

Time to return to sport by stress fracture radiographic findings
Stress fracture type Recovery time
Metatarsals (not proximal second/fourth/fifth) 3 to 12 weeks
Tibia (posteromedial) 2 to 7 weeks (average 3.5)
Fibula 10 to 13 weeks
Femoral neck (compression-side, non-surgical treatment) 4 to 32 weeks (average 7.4 weeks if MRI grade 1; average 15 weeks if MRI grade 2 to 4)
Low-risk site* and low-grade severity on MRI/bone scan 8.7 weeks
High-risk siteΔ and low-grade severity on MRI/bone scan 19.3 weeks
Low-risk site and high-grade severity◊ on MRI/bone scan 21.8 weeks
High-risk site and high-grade severity on MRI/bone scan 18.7 weeks
MRI: magnetic resonance imaging.
* Low-risk sites: Metatarsal shafts 2,3,4; posterior tibial cortex, fibula, tarsals other than talus or navicular, pelvis, femoral shaft.
¶ Low-grade severity: Grades 1 or 2 on MRI or bone scan.
Δ High-risk sites: Base of second metatarsal, fifth metatarsal, tarsal navicular, talus, femoral neck, patella, medial malleolus, great toe sesamoids.
◊ High-grade severity: Grades 3 or 4 on MRI or bone scan.
References:
  1. Beck BR, Matheson GO, Bergman G, et al. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am J Sports Med 2008; 36:545.
  2. Henningsen A, Hinz P, Lüdde R, et al. [Retrospective analysis of march fractures in the german armed forces in the years 1998 to 2000]. Z Orthop Ihre Grenzgeb 2006; 144:502.
  3. Heaslet MW, Kanda-Mehtani SL. Return-to-activity levels in 96 athletes with stress fractures of the foot, ankle, and leg: a retrospective analysis. J Am Podiatr Med Assoc 2007; 97:81.
  4. Dobrindt O, Hoffmeyer B, Seidensticker M et al. Estimation of return-to-sports-time for athletes with stress fractures - an approach combining risk level of fracture site with severity based on imaging. BMC Musculoskeletal Disorders 2012; 13:139.
  5. Ramey LN, McInnis KC, Palmer WE. Femoral neck stress fracture: can MRI grade help predict return-to-running time? Am J Sports Med 2016; 44:2122.
Courtesy of Kevin deWeber, MD.
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