Stress Fractures
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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