Overview
Stress fractures are tiny cracks that occur in a bone due to repetitive force, often resulting from overuse or sudden increases in physical activity. They commonly affect weight-bearing bones in the lower leg and foot, and can be caused by factors such as high-impact sports, sudden increases in exercise intensity, or weakened bones. Symptoms include gradually worsening pain, tenderness, and swelling around the affected area. It is important to contact a doctor if pain becomes severe or if it persists during rest. Proper prevention measures include starting exercise programs gradually, using proper footwear, and incorporating low-impact activities to avoid repetitive stress.
Understanding the disease
Symptoms
The symptoms of stress fractures can include pain in the affected area that tends to worsen with time, tenderness around the painful spot, and swelling around the painful area. The pain usually begins at a specific point and decreases during rest. If the pain becomes severe or persists even during rest or at night, it's best to contact a doctor.
Risk Factors
Risk factors for developing stress fractures include:
- Engaging in high-impact sports such as track and field, basketball, tennis, dance, or gymnastics.
- Suddenly shifting from a sedentary lifestyle to an active training regimen or rapidly increasing the intensity, duration, or frequency of training sessions.
- Having abnormal or absent menstrual periods, which is more common in women.
- Having flat feet or high, rigid arches.
- Worn footwear.
- Conditions that weaken bones, such as osteoporosis.
- Previous stress fractures.
- Eating disorders and lack of vitamin D and calcium.
Development
Stress fractures develop due to repetitive force on a bone, often from overuse or increased activity. When the load on a bone increases, the bone adapts gradually through a process called remodeling. During remodeling, bone tissue is destroyed (resorption) and then rebuilt. However, if the bone is subjected to unaccustomed force without enough time for recovery, bone tissue is resorbed faster than the body can replace it, making the bone more susceptible to stress fractures. The risk factors for stress fractures include engaging in certain sports, increasing activity levels too quickly, sex, foot problems, weakened bones, previous stress fractures, lack of nutrients, and certain medical conditions.
Assessment and Diagnosis
Triage
You should see a doctor if stress fractures are suspected when you experience severe pain or pain that worsens during rest or at night.
Diagnosis
To diagnose stress fractures, doctors typically use a combination of medical history, physical examination, and imaging tests. Imaging tests are often necessary to confirm a stress fracture, as they may not be visible on regular X-rays taken soon after the pain begins. Common imaging tests used for stress fracture diagnosis include X-rays, bone scans, and magnetic resonance imaging (MRI). MRI is considered the most reliable method for diagnosing stress fractures as it can visualize lower-grade stress injuries and distinguish between stress fractures and soft tissue injuries.
Management and Treatment
Complications
Potential complications of stress fractures include chronic problems or the development of additional stress fractures. Stress fractures that don't heal properly can lead to ongoing pain and discomfort, and if the underlying causes are not addressed, you may be at a higher risk of experiencing further stress fractures in the future.
Prevention
Stress fractures can be prevented by taking certain precautions. Here are some preventive measures that can help reduce the risk of stress fractures:
- Make changes slowly: When starting a new exercise program, it's important to begin slowly and progress gradually. Avoid increasing the amount of exercise by more than 10% per week to prevent excessive stress on the bones.
- Use proper footwear: Wear shoes that fit well and are appropriate for the activity. If you have flat feet or high arches, consult your doctor about using arch supports in your shoes.
- Cross-train: Incorporate low-impact activities into your exercise routine to avoid putting repetitive stress on a specific part of your body. This helps to distribute the stress evenly.
- Maintain good nutrition: Ensure that your diet includes adequate amounts of vitamin D and calcium, as these nutrients are essential for bone health. Avoiding eating disorders can also help prevent stress fractures.
- Strengthen your bones: Engage in weight-bearing exercises such as walking, running, or weightlifting to strengthen your bones and reduce the risk of stress fractures.
- Listen to your body: If you experience pain or discomfort during physical activity, rest and take appropriate measures to address the issue. Ignoring pain can lead to further injury and increase the risk of stress fractures. By following these preventive measures, you can significantly reduce the likelihood of developing stress fractures.
Treatment
To treat stress fractures, the key is to give the bone time to heal. This typically involves rest, ice, and immobilization. You may need to wear a walking boot, brace, or use crutches to reduce the weight-bearing load on the affected bone. In some cases, surgery might be necessary, especially if the fracture is in an area with poor blood supply or for elite athletes who want to return to their sport quickly. Follow your doctor's recommendations on medications, such as over-the-counter pain relievers or prescription narcotics, to manage pain. It is important to attend follow-up appointments for X-rays to ensure proper healing.
Preparing for medical consultation
To prepare for an appointment for stress fractures, you should:
- Be aware of any pre-appointment restrictions and ask about them when you schedule the appointment.
- Write down any symptoms you're experiencing, including those that seem unrelated to the reason for the appointment. Be specific and detailed in describing your symptoms.
- Note any key personal information, including physical traumas, repetitive physical activities, and any previous fractures.
- Make a list of all medications, vitamins, or supplements you take, including doses.
- Prepare a list of questions to ask your doctor, such as the likely cause of your symptoms, necessary tests, whether you need to stop your activity, and if a specialist consultation is needed.
- Bring a family member or friend along to help you remember the information provided during the appointment.