Stress Fracture

Definition

A stress fracture is a tiny crack in the bone that is not caused by a blow to the bone, but is typically caused by repeated stress or overuse. Most stress fractures occur in the lower leg and foot, but they can also occur in the hip and other areas. Most stress fractures can heal spontaneously. However, some may progress to complete fractures, or may require surgery.

Causes

A stress fracture develops from continued physical stress on the bone rather than from a single blow to the bone. It can be caused by:

• Increasing the amount or intensity of an activity too quickly (most common)
• Switching to a different playing or running surface
• Wearing improper or old shoes

Stress fractures can be made worse by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a stress fracture include:

• Sex: female
• Certain sports, especially involving jumping or running:
  
  • Tennis
  • Track, especially distance running
  • Gymnastics
  • Dance
  • Basketball
• Amenorrhea : not menstruating (women only)
• Reduced bone thickness or density
• Poor muscle strength or flexibility
• Overweight or underweight
• Poor physical condition

Symptoms

Symptoms include:

• Localized pain on the bone
• Pain when pressure is applied directly over the fracture and the area immediately around it
• Pain when putting stress on the affected leg
• Swelling and warmth at the site of the injury

Diagnosis

The doctor will ask about your symptoms and medical history, and examine the injured area for localized pain and swelling.

Tests may include:

• X-ray —a test that uses radiation to take pictures of structures inside the body, especially bone. Stress fractures are microscopic and usually not detectable on an x-ray until at least two weeks after symptoms begin.
• MRI scan —a test that uses magnetic and radio waves to show swelling and inflammation inside the bone
• Bone scan —a test that uses a short-lived radioactive substance to show a stress fracture

Treatment

Treatment includes:

Prevention

To reduce your chance of getting a stress fracture:

• Wear proper footwear.
• Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
• Gradually increase the amount and intensity of an activity.
• Do not overdo any activity.
• Eat a healthful diet, including foods rich in calcium and vitamin D .
• Avoid smoking.