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Stress Fractures

Definition :
Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse — such as repeatedly jumping up and down or running long distances. Stress fractures also can arise from normal use of a bone that's been weakened by a condition such as osteoporosis.

Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Track and field athletes are particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you're starting a new exercise program, for example, you may be at risk if you do too much too soon.

Your doctor might diagnose a stress fracture with magnetic resonance imaging (MRI) or another imaging technique. Treatment often involves icing the affected area and plenty of rest. Severe stress fractures may require splinting, casting or surgical insertion of a pin into the bone to promote healing.

Causes :
Stress fractures are caused by the repetitive application of force. Two types of stress fractures are possible :
  • Fatigue fractures. If a normal bone is subjected to overuse or repetitive stress beyond its ability to repair itself, it may crack. This is known as a fatigue fracture. These fractures often occur during high-impact activities such as running and jumping, but they can also occur as a result of prolonged activities such as hiking or walking.
  • Insufficiency fractures. When a weak bone — such as one deficient in minerals or weakened by osteoporosis — cracks under the stress of routine activity, it's known as an insufficiency fracture.

Most stress fractures occur in the weight-bearing bones of the lower leg and foot, particularly the bones that run from the midfoot to the toes (metatarsal bones) and the large bone in the front of the lower leg (tibia).

Risk Factor :
You may be at increased risk of stress fractures if you :

  • Are an athlete who participates in high-impact sports such as track and field, basketball, tennis or gymnastics
  • Are a female athlete with abnormal or absent periods
  • Suddenly shift from a sedentary lifestyle to an active training regimen — such as a military recruit subjected to intense marching exercises — or rapidly increase your exercise length and intensity
  • Have flat feet or high, rigid arches
  • Have osteoporosis or other conditions that lead to weakened bones or decreased bone density

Adolescents whose bones haven't yet fully hardened also may be susceptible to stress fractures.

When to seek medical advice :
If you experience pain during physical activity or other signs or symptoms of a stress fracture, consult your doctor. Prompt diagnosis and treatment can help prevent further injury.

Symptoms :
If you have a stress fracture, you may experience :
  • Pain that increases with activity and decreases with rest
  • Pain that occurs earlier in your workout in each successive workout
  • Pain that increases over time
  • Pain that persists even at rest
  • Swelling
  • A spot that feels tender or painful to the touch

At first, stress fractures may be barely noticeable. But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.

Diagnosis :
Your doctor will ask about your signs, symptoms and recent physical activity, and check for swelling or tenderness. Stress fractures may not be apparent on regular X-rays until about three to four weeks after signs and symptoms begin. If your X-rays appear normal but your doctor suspects a stress fracture, the diagnosis may be confirmed with various imaging techniques — including magnetic resonance imaging, bone scans or computerized tomography (CT).

Complications :
Some stress fractures don't heal properly. This may lead to chronic pain.

Treatment often focuses on simple self-care measures.

  • Rest. At first, it's important to give the bone time to heal. This may take four to 12 weeks or even longer. To reduce the bone's weight-bearing load while it heals, you may need to modify your activities, wear a walking boot or brace, or use crutches.
  • Ice. To reduce swelling and relieve pain, your doctor may recommend applying ice packs to the injured area as needed — up to three to four times a day for 10 minutes at a time.
  • Pain relievers. If needed, take acetaminophen (Tylenol, others) to relieve pain. Some research suggests that nonsteroidal anti-inflammatory pain relievers — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — can interfere with bone healing.

In more severe cases, the doctor may need to immobilize the affected bone with a splint or cast. Sometimes a pin must be surgically inserted into the bone to hold it together and promote proper healing. Recovery from surgery may take up to six months.

When your doctor gives the OK, slowly progress from non-weight-bearing activities — such as swimming — to your usual activities. As you become more mobile, your doctor may recommend working with a physical therapist. The therapist can help you pace your increase in activity and practice strength and stability exercises.

Simple steps can help you prevent stress fractures.

  • Start any new exercise program slowly, and progress gradually. Don't exercise too hard or too long.
  • Avoid sudden changes in intensity or type of exercise.
  • Use proper equipment and footwear appropriate for your activity.
  • Cross-train or alternate activities to avoid repetitively stressing a particular part of your body.
  • If you have flat feet, ask your doctor about arch supports for your shoes.

Nutrition counts, too. To keep your bones strong, make sure your diet includes plenty of calcium and other nutrients.

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.
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