Your Health - Stress Fracture

Stress Fracture

(Fracture, Stress)

Definition

A stress fracture is a tiny crack in the bone. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas. Most stress fractures can heal spontaneously. However, some may lead to complete fractures, or may require surgery.

Stress Fractures of the Tibia and Fibula

Causes

A stress fracture is not caused by a blow to the bone. 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

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 (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 around it
Pain when putting stress on the affected leg
Swelling and warmth at injury site

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 very tiny and usually not seen on an x-ray until at least two weeks after symptoms begin.
MRI scan —a test that uses magnetic 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:

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 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 at least 6-8 weeks.

Crutches or a Cane

You may need crutches or a walking cane to keep pressure off the leg.

Activity

Talk with your doctor about when you can restart activity and how to progress with the amount and type of activity.

A common progression:

Begin with non-weight–bearing activities, such as swimming or bicycling.
Next, you can do weight-bearing, non-impact 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 pre-injury activity level. You can return to full activity once you do not 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 Surgeons
http://www.aaos.org/

American Orthopaedic Society for Sports Medicine
http://www.aossm.org/

American Podiatric Medical Association
http://www.apma.org/

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

Canadian Orthopaedic Foundation
http://www.canorth.org/

References:

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.

Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician . 2003;68(8).

Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112 . Updated October 2007. Accessed June 25, 2008.

Stress fractures. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/health/stress-fractures/DS00556 . Updated November 3, 2006. Accessed June 25, 2008.

Wells CL. Women, Sport & Performance: A Physiological Perspective . Champaign, IL: Human Kinetics; 1991.

Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med . 2005;39:65-69.

Last reviewed October 2009 by John C. Keel, MD

Please 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.