{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:15:10Z","timestamp":1792062910475,"version":"4.4.0"},"reference-count":64,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Stress fractures (SFs) are a common overuse injury in athletes and represent the severe end of the bone stress injury (BSI) continuum. They result from repetitive mechanical loading exceeding the bone\u2019s capacity for adaptation and are associated with impaired performance, prolonged time away from sport, and risk of recurrence if not appropriately managed. This narrative review provides a clinically oriented synthesis of current evidence on the epidemiology, pathophysiology, risk factors, diagnosis, management, and prevention of SFs in athletes. Particular emphasis is placed on modifiable contributors, including training load errors, neuromuscular fatigue, and low energy availability within the framework of Relative Energy Deficiency in Sport (RED-S). Diagnostic evaluation is discussed using a stepwise clinical approach integrating history, physical examination, targeted laboratory assessment, and imaging, with magnetic resonance imaging (MRI) as the reference standard for early detection and severity grading. Management is presented through a risk-based framework combining MRI severity and anatomical site classification to guide treatment decisions and return-to-sport pathways. While most low-risk SFs respond to conservative strategies, high-risk lesions require closer monitoring and, in selected cases, early surgical consideration. This review proposes a practical clinical framework to support decision-making in athletes with suspected or confirmed SFs, aiming to improve early diagnosis, optimize management, and reduce recurrence risk in sports medicine practice.<\/jats:p>","DOI":"10.3390\/jcm15083077","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T11:53:46Z","timestamp":1776426826000},"page":"3077","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Stress Fracture in Athletes: A Practical Approach"],"prefix":"10.3390","volume":"15","author":[{"given":"Federica","family":"Presutti","sequence":"first","affiliation":[{"name":"Departmental Faculty of Medicine and Surgery, UniCamillus Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Paoletti","sequence":"additional","affiliation":[{"name":"Departmental Faculty of Medicine and Surgery, UniCamillus Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Conte","sequence":"additional","affiliation":[{"name":"Cardiology and Sport Medicine Department, Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza, 31045 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-4275","authenticated-orcid":false,"given":"Andrea","family":"Demeco","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Sirico","sequence":"additional","affiliation":[{"name":"Public Health Department, University of Naples Federico II, 80123 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Gnasso","sequence":"additional","affiliation":[{"name":"Public Health Department, University of Naples Federico II, 80123 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-4977","authenticated-orcid":false,"given":"Marco","family":"Vecchiato","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, University of Padova, 35122 Padova, Italy"},{"name":"Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7054-5581","authenticated-orcid":false,"given":"Veronica","family":"Baioccato","sequence":"additional","affiliation":[{"name":"Sports and Exercise Medicine Division, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5793-3221","authenticated-orcid":false,"given":"Alessandro","family":"Corsini","sequence":"additional","affiliation":[{"name":"Genoa Cricket and Football Club, 16155 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2474-3696","authenticated-orcid":false,"given":"Simone","family":"Cerciello","sequence":"additional","affiliation":[{"name":"Departmental Faculty of Medicine and Surgery, UniCamillus Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4924-5549","authenticated-orcid":false,"given":"Matteo","family":"Guzzini","sequence":"additional","affiliation":[{"name":"Departmental Faculty of Medicine and Surgery, UniCamillus Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1558-4857","authenticated-orcid":false,"given":"Stefano","family":"Palermi","sequence":"additional","affiliation":[{"name":"Departmental Faculty of Medicine and Surgery, UniCamillus Saint Camillus International University of Health Sciences, 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1136\/bjsports-2016-096278","article-title":"2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy","volume":"50","author":"Ardern","year":"2016","journal-title":"Bern. 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