Stress Fractures

Definition:

Stress fractures are tiny, incomplete breaks or cracks in a normal bone caused by repeated trauma or pounding. One of the most misdiagnosed of athletic injuries, stress fractures can happen after a short period of stress, but more commonly after a longer period of continued trauma. When the bone cells cannot rebuild as fast as the repetitive trauma damages them and the bone can take no more stress, the crack occurs. Stress fractures can occur in both the upper and lower body, but they are most common in the foot.

Symptoms:

The pain related to a stress fracture begins gradually and intensifies with continued activity. Pain however is not always present as an early warning, or it is often ignored by the athlete. Swelling and tenderness may also affect the area. One of a physician's best methods in determining a stress fracture is if pain is felt when pressure is applied from above and below. X-rays of the injured site should be taken, though the fracture may not show up for the first 5 to 10 days after the injury. When stress fractures are ignored the results can be serious. Complete breaks in the bone, especially in the hip area, may necessitate surgery or prolonged disability.

Causes of Injury:

  • Switching to a harder running surface.
  • Rapid increase of speed or distance.
  • Returning to intense activity after a layoff.
  • Inadequate rest and excessive stress.
  • A change in footwear without proper adjustment period.
  • Improper shoe selection to accommodate foot type.

Short Term Treatment:

  • Discontinue the injurious activity immediately.
  • Rest.
  • Ice.
  • Elevation.
If pain and swelling do not subside after a few days of self-prescribed care, and if athletic as well as normal activities become difficult, professional help should be sought.

Long Term Treatment:

  • Non-impact aerobic activity such as swimming, rowing, cross-country skiing, walking or bicycling to maintain cardiovascular fitness.
  • A cast may be used in tibial (lower leg) stress fractures. Metatarsal (foot) stress fractures may require casting for 4 to 6 weeks because these bones are more difficult to immobilize.
  • A heel cup or special protective padding for heel fractures.
  • Crutches to relieve the pressure and weight from the leg.
  • Oral, nonsteroidal anti-inflammatory medications to alleviate pain and swelling.
The return to athletic activity should be delayed for as long as possible - from 4 to 6 weeks - depending on the location and severity of the injury. Though the pain may subside after the second week of treatment, returning to a normal exercise routine can delay healing and can cause permanent damage.

 

Information and graphics provided by the American Running and Fitness Association.