Stress Fractures and Recovery For Hikers

by | Oct 31, 2018 | 0 comments


  • Stress fractures and shin splints account for nearly 23% of hiker injuries each year
  • Many causes including: physical stress, poor nutrition, overuse, excess pack weight
  • Ways to help avoid stress fractures

The Numbers

According to a 2017 survey of Appalachian Trail hikers, 17% dealt with shin splints, a type of stress fracture, and another 6.3% had a reported a stress fracture. So why are nearly combined 23% of hikers having stress fractures? Let’s dive in!

A Bit On Bones

Bones are continually breaking themselves down and rebuilding. It’s the secret life of bones. Whatever stress you apply to the bones the body will respond to. It will build a stronger bone if you run or hike a lot, and in the absence of stress, a thinner weaker bone will emerge. This is also known as Wolff’s Law. Remember, the body is all about resource conservation!

What Is A Stress Fracture?

Stress fractures are a partial or complete break in the bone caused by constant stress and poor ability to regrow new bone. It is actually a microfracture of the bone, leading to inflammation of the tissue that attaches to the bone, and irritation of the muscles that attach to or support the area.

For hikers, it will present as “shin splints” or foot pain during hiking. Stress fractures are hard to diagnose when they happen because they don’t typically show up in x-rays very well; once they begin to heal they are more easily identified.

What Causes A Stress Fracture?

With a stress fracture caused while thru-hiking, the bones are being broken down like usual, but now have a harder time regenerating due to limited/competing resources from a less nutrient-rich diet. The stress and overuse can come from many areas including:

  • Pack weight
  • Uneven terrain
  • Hiking too many miles too soon
  • Poor nutrition
  • Weak feet and lower leg muscles
  • Lack of proper training
  • Bad trip or fall

Indicators Of A Possible Stress Fracture

Typically, you will have some pretty unavoidable pain, which is a late indicator that something is not right. Don’t ignore that by just taking some ibuprofen! Pain is the predominant indicator of a stress fracture. There may also be swelling, bruising and the area will be tender to the touch.

Expect less pain during rest, more with activity. It may start gradually and then become worse throughout the day. Also, you don’t necessarily need blunt force trauma like a trip or fall to create a fracture. Simple overuse is enough in this case.

Download the free article on ways that you can improve your odds of being successful during your through hike!

Hikers frequently brush off pain and fight through for hundreds of more miles. You’ll tell yourself you can still walk on it, so it must not be that bad. The truth is, you are making it much worse by irritating fracture and surrounding tissue, lengthening your recovery process. More on that later

Types of Stress Fractures

Medial Tibial Stress Syndrome aka “Shin Splints”

Since shin splints is a pretty generic term for any lower leg pain, Medial Tibial Stress Syndrome (MTSS) is a more appropriate term for stress fractures of the Tibia. The Tibia is the thicker of the two lower leg bones; the other is the Fibula.


Medial simply refers to the inside edge of the Tibia, and in non-scientific language, MTSS is: inside lower leg stress syndrome.

Pain with MTSS will present on the mid to lower portion of the lower leg. You’ll be tender along the muscles that lay just to the outside of your Tibia and maybe along the back of your leg also.

Metatarsal Fractures

It seems to be the third, fourth and fifth metatarsal bones that are most often injured. Metatarsals are the longer bones in your feet, starting from the end of the arch and stopping before the smaller toe bones.

Hikers who overpronate tend to be at more risk here as the muscles are stretched out and unable to support the bones properly. Over the counter orthotics like Superfeet can help support your feet and worth the investment.


My experience working in physical therapy tells me that people over-estimate how quickly they can return to their activity of choice. Recovery for fractures will vary depending on a few factors. How well you replenish your body with quality food before and during your hike, your age, sex, training level, overall health and how long you kept hiking before you took action.

The physiological demands on the body sky-rocket with a thru-hike, that’s why we stress such good nutrition during a hike! This is where having a better trail diet can really help you!

It takes the body a fairly predictable amount of time to remodel and repair itself, and that time frame needs to be respected. You are going to need to take time off the trail, but how long is hard to say. Typically, weeks.

You need time off to let the fracture heal and by not doing so, you will impair the healing process. If you jump back on the trail too soon and you are not fully healed, you will develop a linear fracture, eventually progressing to a displaced fracture. That means you get to wear a really neat plastic and velcro boot for weeks or crutches to stay off of your foot while it heals!

You should not return to the trial until an x-ray can confirm that bone has healed and is stable. Even then, strength, stretching and slow progression are the name of the game.

You will want to visit a physical therapist or for more detailed stretches and a proper diagnosis but a general rehab program will consist of the following:

  • Ice for the first 24-48hrs
  • Rest
  • Stretching
  • Strengthening
  • Low impact activity (especially for foot fractures)


  • Train more beforehand! Hike more often, walk barefoot in your yard, park, beach or house to help strengthen the muscles in your feet.
  • Stretch the Tibialis Anterior in the front of your shin
  • Massage tender muscles to promote blood flow and healing
  • When possible, soak feet, legs in cool running water while on the trail
  • Make more informed food choices on the trail. Higher nutrient density will allow your body to recover better and keep some of these problems from ending your trip.
  • Start slow and work your way up to longer miles! This is truly a marathon, not a sprint. Hiking 2000+ miles takes months to do.
  • Drop the pack weight before you go! Remember that hikers tend to pack for their fears and use that to help determine where you can shed over packing.

Be sure to like our Facebook page and follow us on Instagram and Twitter!

You can reach me with any injury issues, past or present that you feel will impact your hike. Training questions are also welcome – I am happy to help!