Background: Female recruits are known to have a relatively high incidence of stress fractures (SF). This has been apparent also when female recruits entered the Israel Border Police training program.

Aims: To examine the influence of various interventions including shoe modification, nutrition, controlled training program and pre-recruit course on the incidence of SF.

Methods: Between February 1996 and February 1998, five courses of female recruits were held with a total of 229 participants. The four later courses were controlled and strictly documented. These included 203 recruits. The total number of SF was recorded using bone scintigraphy. “Dangerous SFX” was described as those SF including the long bones of the lower limb and the navicular bone. Due to high number of SF the organic medical team introduced various interventions: 1. Shoes were replaced with lither and flexible shoes with soft absorbing soles (course I onward). 2. Nutrition was modified (course II onward). 3. A training scale was programmed and introduced (course III onward). 4. Selecting candidates six months before recruitment and running a three-month preparation course (course IV onward).

Results: 1) 55 recruits (of 203) or 27.1% suffered SF grade I or more (2.9 SF for injured recruit or 0.78 SF for each recruit in the course. 2) 36 recruits (of 203) or 17.7% suffered SF grade II or more (2.1 SF for injured recruit or 0.37 SF for each recruit in the course. 3) The data concerning 229 recruits along the 5 courses was recorded and found that the incidence of number of recruits suffering dangerous SF in all grades, or grade II or higher, and the number of dangerous SF per recruit was reduced gradually from course to course.

Conclusions: The incidence of stress fractures in female recruits during basic training is high, ranging in the series for the various courses from 23% to 35% for all grades and from 8.3% to 19% for “dangerous” SF (basically of the long bones) graded II onward. Various interventions including shoe modification, nutrition, controlled training program and pre-recruit course seems to have a possible combined effect in reducing the incidence and severity of stress fractures, especially those termed “dangerous stress fractures”.