Stress Fractures

A stress fracture is described as a small crack in the bone which often occurs from an overuse injury. It commonly develops in the weight bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress effectively. When this happens the muscles transfer the stress to the bone which results in a stress fracture.

Stress fractures are often caused by a rapid increase in the intensity of exercise. They can also be caused by a sudden increases in physical activity levels, training on a hard surface and improper footwear. Athletes participating in certain sports such as basketball, tennis or gymnastics are at a greater risk of developing stress fractures. 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 limb which usually gets worse during exercise and decreases upon resting. Night pain is a feature which should always be investigated.

Your doctor will diagnosis the condition following a thorough history and examination. Diagnostic tests such as X-ray, MRI scan or bone scan may be required.

Treatment

Stress fractures can be treated by a non-surgical approach. This includes relative rest and limiting the physical activities that caused the injury.

Protective footwear may be recommended which helps to reduce stress on the effected bone. Your doctor may also advise a cast or walking boot.

Surgery is rarely required for a stress fracture, however may be considered in certain circumstances.

Some of the following measures may help to prevent stress fractures:

• Ensure to start any new sport activity slowly and progress gradually. A general rule of thumb is to progress your training volume or intensity by 10% per week.
• 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 every day to reduce the risk of injury from overuse. This limits the stress occurring on specific muscles as different activities use muscles in different ways.
• Maintain a healthy diet and include calcium and vitamin D-rich foods
• Use appropriate footwear and avoid using old or worn out shoes
• If you experience pain and swelling, then immediately stop the activities