A stress fracture is a tiny crack in the bone that is not caused by a blow to the bone. Most stress fractures occur in the lower leg and foot.
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:
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Increasing the amount or intensity of an activity too quickly (most common)
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Switching to a different playing or running surface
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Wearing improper or old shoes
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a stress fracture include:
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Sex: Female
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Certain sports:
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Amenorrhea--not menstruating (women only)
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Reduced bone thickness or density
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Poor muscle strength or flexibility
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Overweight or underweight
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Poor physical condition
Symptoms
Symptoms include:
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Localized pain on the bone
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Pain when pressure is applied directly over the fracture and the area immediately around it
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Pain when putting stress on the affected leg
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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–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:
Drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain.
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.
Crutches or a Cane
You may need crutches or a walking cane to keep pressure off the leg, but most people do not.
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 is as follows: 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 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:
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Wear proper footwear.
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Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
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Gradually increase the amount and intensity of an activity.
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Do not overdo any activity.
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Eat a healthful diet, including foods rich in calcium and vitamin D.
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
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;11:73-6.
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 Oct 15;68(8).
Women, Sport, & Performance. Human Kinetics; 1991.
