By: Corinne Gehegan, DPM
Stress fractures may develop in any bone; however, those of the lower extremity such as the shin and the foot are more prone. A fracture is a break in the bone that may be the result of a direct significant force such as a heavy object or falling from a height. A stress fracture or a fatigue fracture is associated with the bone being subject to lower forces repeatedly over a period of time. It is often the result of “too much too soon” or overuse.
Bone consists of cells that are responsible for creating new bone and cells that are responsible for absorbing old bone. Ideally, bone metabolism works in equilibrium. However, in the case of stress fractures, bone is breaking down quicker than it is building up. This results in a weak spot that presents as a stress fracture.
Diagnosis is based on a thorough medical history and an activity history. Foot wear lacking support may also be implicated. Deciding to walk 50 city blocks with flip flops throughout the first warm Spring day is a classic example of a precluding event. History and clinical exam will usually point to the diagnosis. Stress fractures are sometimes associated with swelling and redness. A stress fracture does not usually present itself on X-ray and evidence may only show up weeks after the onset of symptoms as a fuzzy area around the bone representing the bone attempting to heal itself. An X-ray may be used to rule out a bone tumor or other bone/joint abnormality. MRI will provide a definitive diagnosis in most cases, but is not absolutely necessary.
Treatment involves rest from athletic activities and excessive walking/weight bearing. It is often prudent to use a surgical shoe or walking boot to prevent delayed healing or displacement. Crutches may also be used.
Prevention is important and this is achieved by identifying all factors that may have led to the injury in the first place. Menstrual irregularities, nutritional factors, and bone density should be considered in addition to recent activity level.
Article written by Dr. Corinne Gehegan
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