Tibial Stress Fracture

ExitCare ImageA stress fracture is a break in the bone, caused by repeated or intense exercise and prolonged pressure on the bone. Stress fractures may pass fully through the bone (complete) or partially (incomplete). The shinbone (tibia) is a common place for athletes to develop a stress fracture.

SYMPTOMS

  • Indistinct, spread out pain or ache.

  • Tenderness and swelling in the leg or calf (sometimes).

  • Bleeding and bruising in the leg (uncommon).

  • Weak and unable to bear weight on the injured leg.

  • Paleness and deformity (sometimes).

CAUSES

Stress fractures result from small injury (microtrauma) to a bone, repeatedly injured faster than it can heal. This makes the bone weak and vulnerable to fracture. Stress fractures often follow changes in training schedule, equipment, or intensity of activity. They may also be affected by loss of menstrual period in women.

RISK INCREASES WITH:

  • Previous stress fracture.

  • Military recruits, especially distance runners.

  • Bone problems (i.e. osteoporosis or bone tumors).

  • Metabolism disorders and hormone problems.

  • Nutritional deficiency and disorders (anorexia or bulimia).

  • Loss of, or irregular menstrual periods in women.

  • Poor strength and flexibility.

  • Sudden increase in length, intensity, or frequency of physical activity.

  • Running on hard surfaces.

  • Poor leg and foot alignment, including flat feet.

  • Inadequate footwear with poor shock absorbers.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Leg muscle strength.

  • Endurance and flexibility.

  • Cardiovascular fitness.

  • Wear proper fitting footwear. Change shoes after 300 to 500 miles of running.

  • Learn and use proper exercise technique.

  • Increase activity and training gradually.

  • For women with irregular menstrual periods, treat hormonal disorders (such as, with birth control pills).

  • Correct metabolism and nutrition disorders.

  • For runners with flat feet, wear cushioned arch supports.

PROGNOSIS

Stress fractures are often curable, if treated properly. Time required before returning to sports varies greatly, depending on the degree of injury and treatment methods.

RELATED COMPLICATIONS

  • Fracture fails to heal (nonunion), especially if fracture is in the middle third of the shinbone.

  • Fracture heals in a poor position (malunion).

  • Recurring stress fracture.

  • Stress fracture becomes a complete and displaced fracture.

  • Risks of surgery: bleeding, injury to nerves (numbness, weakness, paralysis), need for further surgery, bone death.

  • Recurring stress fractures, in a different bone or location. (Occurs in 1 in 10 patients.)

TREATMENT

Treatment first involves ice, medicine and stopping any aggravating activities, to reduce pain and inflammation. The lower leg and ankle may be restrained to allow healing. Sometimes, crutches are advised. Menstrual, nutrition, and metabolism problems need to be determined and treated properly to help healing and prevent recurrence. After restraint and rest, it is important to return to sports gradually, only after permission from your caregiver. Strengthening and stretching exercises may help you regain strength and a full range of motion. Surgery is usually not needed, but may be advised for fractures that do not heal after 6 months of non-surgical treatment.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines, (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

  • Ointments applied to the skin surface may help.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • The following occur after restraint or surgery ( Report any of these signs immediately ):

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site (especially under the toenails), or numbness and loss of feeling below the fracture site.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)