Stress Fractures

A stress fracture is described as a small crack in the bone which occurs from an overuse or repetitive injury to a bone. It commonly develops in the weight bearing bones of the lower extremity, be it be hip, thigh, leg or foot. Stress fracture in spine can present as Spondylolisthesis of vertebra. When the muscles 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 can be 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. Athletes participating in certain sports such as basketball, tennis or gymnastics are at a greater risk of developing stress fractures. During these sports the repetitive stress on a hard surface causing trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop stress fracture.

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 pain in the foot 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, MRI scan or bone scan may be required to confirm the fracture.

Treatment

Stress fractures can be treated by non-surgical approach which includes rest and limiting the physical activities. 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. Re-injury can also occur without allowing the stress fracture to completely heal.

Protective footwear may be recommended which helps to reduce stress on the foot. Your doctor may apply cast to the foot to immobilize the leg which also helps to remove the stress. Crutches may be used to prevent the weight of the foot until the stress fracture is healed completely. Similarly bracing can be helpful in stress fractures of spine or around the knee.

Surgery may be required if the fracture is not healed completely by non-surgical treatment. Surgery is done to improve the biology of the area as well as protection by using screws, nails, pins etc. to enhance healing.

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

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content, and have written most of it myself.