Early treatment with rest and therapy often avoids the need for surgery
By ALEC MACAULAY, MD
Stress fractures are common injuries that begin with repetitive and excessive stress on a bone, usually involving the leg or foot. Unlike a traumatic bone fracture, many patients overlook the early stages of stress fractures until the injury worsens, causing significant pain and swelling. Ignoring the pain can lead to worsening of the fracture and occasionally even necessitate surgery.
Typically, stress fractures occur when physical activity or exercise strains a patient’s leg or foot bones beyond their strength. Even moderate activity can cause a stress fracture when patients have not gradually conditioned their bodies and are vitamin D deficient, factors that affect bone strength. After a long winter of inactivity and reduced sunlight that allows our skin to produce vitamin D, many Finger Lakes residents are at risk for stress fractures. That risk can be reduced by easing back into physical activity, cross-training, including non-impact exercises, and talking with your primary physician about using a vitamin D supplement. Patients with eating disorders or conditions resulting in malabsorption of vitamin D, bone loss, or osteoporosis are at greater risk for stress fractures and should consult with their physicians on treatment.
What are the symptoms of a stress fracture?
Pain and swelling at the site of the fracture that gets worse with physical activity are common symptoms. Stress fractures most commonly affect the leg — often the tibia, or shinbone, the foot — frequently the navicular bone located between the ankle and the midfoot, and the metatarsals behind the toes. The fifth metatarsal on the outside of the foot is a common location for a stress fracture.
Who is at risk for a stress fracture?
Women have a slightly higher risk than men. Athletes, military recruits, and those participating in high-impact activities such as gymnastics, basketball, volleyball, soccer, or run over 25 miles per week are more likely to get stress fractures. Smoking, having over 10 alcoholic drinks per week, and lack of exercise are also risk factors. Rapidly increasing physical activity or an exercise program can also cause stress fractures.
How is it diagnosed?
Sometimes a diagnosis is made from a medical history and physical exam, but imaging tests are often needed. Those include:
- X-rays. This is a good initial test for stress fractures but do not catch all stress fractures, especially early fractures.
- Magnetic resonance imaging (MRI). An MRI not only shows stress fractures but can show stress reactions, which are essentially pre-stress fractures.
- Bone scan. The test uses a small dose of radioactive material given through an intravenous line. The radioactive substance is absorbed by areas where bones are being repaired and shows up on the scan image as a bright white spot. This test may be used for patients who cannot get an MRI.
How is a stress fracture treated?
Eliminating the activities that caused the injury and prevent it from healing is essential. Patients may need crutches, casts, walking boots or similar aids for several weeks to rest the bone and let it start to heal. Addressing vitamin D deficiency is also important.
The earlier you visit your doctor about a stress fracture, the sooner you will return to your activities. Most stress fractures heal without problems, but some fractures, such as those in the tibia, may require surgery to heal properly.
Dr. Alec Macaulay is an Orthopedic Surgeon with Cayuga Orthopedics and serves on the medical staffs of Cayuga Medical Center. His clinical interests include both the surgical and non-surgical treatment of athletic injuries, arthritic conditions, and musculoskeletal trauma. He specializes in surgery of the knee, ankle and foot and can be reached at (607) 272-7000.