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Stress Fracture

(Fracture, Stress)

Definition

A stress fracture is a tiny crack in the bone from chronic overuse. Most stress fractures occur in the lower leg and foot. They can also occur in the hip and other areas.
Stress Fractures of the Tibia and Fibula
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Causes

A blow to the bone does not cause a stress fracture. Rather, it is typically caused by repeated stress or overuse. Some causes are:
Stress fractures can worsen by continued physical stress. Smoking can also make stress fractures worse because it interferes with bone healing.

Risk Factors

Stress fractures are more common in women. Other factors that may increase your chance of a stress fracture include:

Symptoms

A stress fracture may cause:

Diagnosis

You will be asked about your symptoms and medical history. The injured area will be examined for localized pain and swelling.
Imaging tests to evaluate your bones include:

Treatment

Treatment includes:

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain, but controversy exists about their use for stress fractures. It is possible that NSAIDs adversely affect stress fracture healing.

Rest

Rest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain. Rest time required is at least 6-8 weeks.

Shoe Inserts or Braces

Shock absorbing shoe inserts and pneumatic braces may provide comfort and quicken recovery.

Crutches or a Cane

You may need crutches or a walking cane to keep pressure off the leg.

Activity

Talk with your doctor about when you can restart activity and how to progress with the amount and type of activity.

Prevention

To help reduce your chance of a stress fracture:

RESOURCES

American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med. 2001;11:73-76.

Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011;83(1):39-46.

Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician. 2003;68(8):1527-1532.

Stress fractures. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112. Updated October 2007. Accessed September 16, 2015.

Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: A review of the literature. PM R. 2010;2:945-949.

Rome K, Handoll HHG, Ashford RL. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database of Systematic Reviews. 2005;2:CD000450.

Wells CL. Women, Sport & Performance: A Physiological Perspective. Champaign, IL: Human Kinetics; 1991.

Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39:65-69.

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