Stress Fracture

Definition

A stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.

Stress Fractures of the Tibia and Fibula

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Causes

A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:

• 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 worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

Risk Factors

Stress fractures are more common in women. Other factors that may increase the chance of a stress fracture include:

• Sports that involve running and jumping, such as:
  • Tennis
  • Track, especially distance running
  • Gymnastics
  • Dance
  • Basketball
• Absence or early stopping of menstrual cycle— amenorrhea
• Reduced bone thickness or density— osteoporosis
• Poor muscle strength or flexibility
• Overweight or underweight
• Poor physical condition

Symptoms

A stress fracture may cause:

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

Diagnosis

You will be asked about your symptoms and medical history. The injured area will be examined for localized pain and swelling.

Imaging tests to evaluate your bones include:

• X-rays —stress fractures are tiny and usually not seen on an x-ray until at least 2 weeks after symptoms begin
• MRI scan
• Bone scan

Treatment

Treatment includes:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.

Rest

Rest is important for a stress fracture. Activities will need to be adjusted during recovery. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks.

Shoe Inserts or Braces

Shock absorbing shoe inserts and pneumatic braces may provide comfort and quicken recovery.

Crutches or a Cane

Crutches or a walking cane may be needed to keep pressure off the leg.

Prevention

To help reduce your chance of a stress fracture:

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