Stress fracture

• Stress fractures were first described in Prussian soldiers by Breithaupt in 1855.1, 2, 3 They were named “walking fractures” and their characteristics were confirmed 40 years later with the advent of radiography.1, 2

• A stress fracture is a tiny crack in the surface of a bone.
• It occurs when the bone tissue has to absorb more weight and impact than it can handle.
• It is a reaction to stress where the bone structure degrades and weakens before cracking.
• This type of injury can occur over time in a bone:
  • Well-conditioned that is overused
  • Under-conditioned that is subjected to excessive stress over a short period of time
• Incidence:
  • Feet
  • Ankle
  • Lower legs
  • Other parts of the body, such as the:
    • Pelvis
    • hip
    • Ribs
    • Sacrum
    • Clavicle
    • Arm
• Common situations that can trigger a bone stress imbalance:
  • Runners who go too fast
  • Ballet dancers who train too long
  • Military recruits who walk too long
• Bone mass is in perfect balance between formation and resorption according to body needs.
• If there is an over demand on the bone system, it is possible that a calcium formation deficit occurs.
• This will be destabilizing to its supportive function and a fracture may occur.
• It is IMPORTANT to give the body time to adapt to the task at hand.
• This principle is also valid for all tissues composing the body

The important thing is not to do it TOO QUICKLY…

Risk factor

• Certain sports.
  • Stress fractures are more common in people who practice high-impact sports
    • Track and field
    • Basketball
    • Tennis
    • Dance
    • Gymnastics.
• Increased level of activity.
  • Stress fractures often occur in people who suddenly switch from a sedentary lifestyle to an active training regimen or who rapidly increase the intensity, duration, or frequency of workouts.
• Gender
  • Women, especially those with abnormal or absent menstrual periods, are at greater risk for developing stress fractures.
• Foot problems.
  • People with flat feet or high, stiff arches are more likely to develop stress fractures.
  • Worn shoes contribute to the problem.
• Weakened bones.
  • Osteoporosis can weaken the bone and make it easier to develop stress fractures.
• Previous stress fractures.
  • Having one or more stress fractures increases the risk of having more.
• Lack of nutrients.
  • Eating disorders and lack of vitamin D and calcium can make bones more susceptible to developing stress fractures.

Cause

• Repetitive and excessive force
  1. Jumping up and down
  2. Long distance running.
• Pathological. A bone weakened by a condition such as osteoporosis.
• Unusual overloading of an impact movement

Symptom

• Swelling
• Bruising
• Tender

Preventive measure

• High quality exercise equipment
• Use of orthopedic insoles
• Ensuring that changes in the duration, frequency or intensity of activity are gradual rather than sudden
• A healthy diet that includes appropriate amounts of calcium and vitamin D

Who are at risk

• Certain sports or participants have impact efforts:
  • Track and field
  • Basketball
  • Tennis
  • Dance
  • Ballet
  • Gymnastics
• Sex:
  • Womens
    • Particularly those who do not menstruate
    • Triad of female athletes
      • Eating disorders
      • Menstrual disorders
      • Premature osteoporosis.
• Foot problems:
  • Inappropriate footwear for sports
  • High arch
  • Rigid foot arch
  • Flat foot
• Weakening of the bone:
  • Osteoporosis
  • Have previous hairline fractures
  • Lack of vitamin D or calcium
  • Lack of sun exposure (winter)
• Foot disorder:
  • Foot Onions
  • Tendonitis

What to do

• Rest
• Stop sports
• The healing period is about 12 weeks.

Reference

1. Breithaupt M.D. Zur pathologie des menschlichen fusses. To the pathology of the human foot. Med Zeitung. 1855;24:169. [Google Scholar]
2. Devas M.B. Stress fractures of the tibia in athletes of ‘shin soreness. J Bone Joint Surg Br. 1958;40(2):227–239. [PubMed] [Google Scholar]
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4. Fayad L.M., Kamel I.R., Kawamoto S., Bluemke D.A., Frassica F.J., Fishman E.K. Distinguishing stress fractures from pathologic fractures: a multimodality approach. Skelet Radiol. 2005;34(5):245–259. [PubMed] [Google Scholar]
5. Niva M.H., Mattila V.M., Kiuru M.J., Pihlajamäki H.K. Bone stress injuries are common in female military trainees: a preliminary study. Clin Orthop Relat Res. 2009;467(11):2962–2969. [PMC free article] [PubMed] [Google Scholar]