Stress Fractures

A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress and when this happens the muscles transfer the stress to the bone which results in stress fracture.

Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by impact on a hard surface, improper footwear, and increased physical activity. Lastly, athletes with inadequate rest between workouts and/or  are increasing their activity level but are not eating a proper diet may also be at risk.  While any athlete can be at risk for stress fractures, those with more repetitive actions are at highest risk.  This can include children participating in certain sports such as basketball, cross country, tennis or gymnastics.  

Females are at a greater risk of developing stress fracture than males, and may be related to a condition referred to as "female athlete triad". It is a combination of eating disorders, amenorrhea (irregular menstrual cycle), and osteoporosis (thinning of the bones). The risk of developing stress fracture increases in females if the bone weight decreases.

The most common symptom is achy pain in the area where the stress fracture is located which usually gets worse during exercises and decreases upon resting. Swelling, bruising, and tenderness may also occur at a specific point.

Your doctor will diagnosis the condition after discussing symptoms and risk factors and examines the foot and ankle. Some of the diagnostic tests such as X-ray or MRI scan may be required to confirm the fracture.

Treatment:

Stress fractures can be treated by non-surgical approach which includes rest and avoiding the physical activities that cause pain. If children return too quickly to the activity that has caused stress fracture, it may lead to chronic problems such as harder-to-heal stress fractures. 

Protective footwear may be recommended which helps to reduce stress in the foot. Your doctor may apply cast to the foot to immobilize the leg which also helps to remove the stress. Crutches may be needed if the stress fracture is still painful with weightbearing.

Surgery may be required if the fracture is not healed completely by non-surgical treatment. For stress fractures of the foot, your surgeon makes an incision on the foot and uses hardware such as wires, pins, or plates to attach the broken bones of the foot together until healing happens after which these fixators can be removed or may be permanently left inside the body.  Stress fractures of the tibia, if not healing with non-surgical treatment, are often treated with a large rod that is placed within the middle of the tibia bone.

The key to treatment of stress fractures is prevention.  Some of the following measures may help to prevent stress fractures:

  • Ensure to start any new sport activity slowly and progress gradually
  • Cross-training: You may use more than one exercise with the same intention to prevent injury. For example you may run on even days and ride a bike on odd days, instead of running everyday to reduce the risk of injury from overuse. This limits the stress occurring on specific muscles as different activities use muscles in different ways
  • Ensure to maintain a healthy diet and include calcium and vitamin D-rich foods in your diet
  • Ensure that your child uses proper footwear or shoes for any sports activity and avoid using old or worn out shoes
  • If your child complains of pain and swelling then immediately stop the activities and make sure that your child rests for few days.  Schedule an appointment today so that your child can be evaluated