Stress Fractures
What is a stress fracture?
A stress fracture is a tiny crack that occurs in the bone; most often in the weightbearing bones of the lower leg and foot. Stress fractures are one of the most common injuries in sports and can affect people of all ages.
Why do stress fractures occur?
Most stress fractures occur as a result of overuse. When an activity involves repetitious force, muscles can become fatigued. Over time, the muscle becomes so fatigued that stress is transferred to the bone and a crack in the bone can develop. Some medical conditions such as osteoporosis can also weaken bone and make the bone more susceptible to a stress fracture. Stress fractures can also occur when there is a dramatic increase in the forces that are placed upon a bone.
Risk factors include:
- High impact activities such as track and field, basketball
- Prolonged hiking
- Gymnastics
- Eating disorders such as anorexia and bulimia
- Osteoporosis or loss of bone mass in aging females
- Infrequent or absent menstrual periods
- Abrupt change in playing surface; ie soft clay court to hard court or indoor basketball court to outside soccer grass field
- Improper equipment; ie worn shoes or poor support
- Abrupt increase in playing time or intensity of activity
Symptoms:
- Initially, minimal to no discomfort
- Pain with activity but pain decreases with rest
- With each work-out session, the onset of pain occurs earlier in the session
- Pain persists even when at rest
- Swelling possible
Diagnosis:
Your physician will take a detailed history asking specific questions about the activities you are participating in and the onset of symptoms. S/he will then do a thorough clinical exam and obtain a baseline x-ray. However, a stress fracture may not be visible on an x-ray for 3-4 weeks following the onset of symptoms. If indicated, your physician may order an MRI at the Imaging Center, as this study can identify the condition more readily than plain x-rays.
Treatment:
- Rest. If the stress fracture is the result of an overuse activity, it is advised that the activity be stopped until your physician indicates otherwise.
- In general, a stress fracture can take from 4-12 weeks to heal. During that time, individuals should limit themselves to pain free activities only.
- Ice. Ice can relieve pain and swelling if applied over a thin cloth 3-4 times a day for 10 minute periods.
- Tylenol may be advised for pain. The use of non-steroidal, anti-inflammatory medications such as Advil and Aleve are not advised, as they may interfere with bone healing.
- Immobilization with a walking boot or splint may be indicated.
- Surgical intervention, such as repair of the bone, if indicated
- Non-weight bearing activities such as swimming initially, with a gradual progression to weight bearing activities, under the direction of your physician
- Referral to physical therapy, if indicated
How to prevent a stress fracture:
- Cross-training; alternating impact and non-impact activities
- Gradual transition to new playing surfaces; limiting initial duration of trainings
- Introduce new sports or activities gradually; limiting intensity and length of sessions
- Avoid sudden changes in duration and intensity of trainings
- Maintain a healthy diet rich in calcium and vitamin D
- Check shoes and equipment frequently and maintain quality
