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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.
Stress Fractures of the Tibia and Fibula
2008 Nucleus Medical Art, Inc.
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 bonePain when pressure is applied directly over the fracture and the area immediately around itPain when putting stress on the affected legSwelling and warmth at the site of the injury DiagnosisThe 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 TreatmentTreatment includes: MedicationsNonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists surrounding their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing. RestRest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is typically at least 6-8 weeks.
Crutches or a CaneYou may need crutches or a walking cane to keep pressure off the leg, but most people do not. ActivityTalk with your doctor about when you can restart activity and how to progress with the amount and type of activity.A common progression is as follows: Begin with non-weight-bearing activities, such as swimming or bicycling. Next, you can do weight-bearing, nonimpact exercise, such as a stair machine. Gradually, you will be able to add low-impact activity, starting with walking. Once you can do fast-paced walking with no pain, you can start higher impact activity, such as light jogging. This gradual progression continues until you have reached your preinjury level of activity. Do not return to full activity until you no longer feel tenderness of the bone. 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. RESOURCES: American Academy of Orthopaedic Surgeonshttp://www.aaos.org
American Orthopaedic Society for Sports Medicinehttp://www.aossm.org American Podiatric Medical Associationhttp://www.apma.org CANADIAN RESOURCES: Canadian Orthopaedic Associationhttp://www.coa-aco.org/ Canadian Orthopaedic Foundationhttp://www.canorth.org/ References: American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org . Accessed October 12, 2005. Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med . 2001;11:73-76. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed October 12, 2005. Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician . 2003;68(8). Wheeler P. Batt ME. Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. British Journal of Sports Medicine. 2005;39:65-69. Women, Sport, & Performance . Human Kinetics; 1991. Last reviewed November 2007 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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