Stress fractures

Stress fractures are a common overuse injury in athletes, but can also occur in non-athletes. They occur when a person has a partial fracture in one of the bones. Unlike with other broken bones, these fractures are not caused by direct impact. Instead, these small breakages usually occur in weight-bearing bones such as the shinbone and foot bones and are caused by trauma accumulated over time.

While stress fractures can happen to anyone, they are most often seen in people who are highly physically active. This injury is seen more frequently in Caucasians due to the fact that they have a lower average bone mass density than other races. This is also the case with women. Women have, on average, lower bone density than men do, and so are more at risk for developing a stress fracture. Children are also at risk because their bones have not yet fully matured, and so are more prone to injury. Treatment varies depending on the severity of the injury. If left untreated, this condition can lead to a complete fracture of the bone.

Anatomy of the bone

The bones are what give the body shape and stability. They consist of the following:

  • The epiphysis (the ends of the bone)
  • The epiphyseal plate
  • The metaphysis (the “neck” area of the bone)
  • The diaphysis (the shaft of the bone)
  • Articular cartilage

The skeletal system shapes the body and protects major organs against damage. Muscles and ligaments attached to the bones help provide stability and support. However, if the muscles become inflamed or twisted, they can ultimately lead to broken bones or infection in and around the bone, which can result in a stress fracture.

Symptoms

Stress fractures have a variety of symptoms. In some cases, the symptoms may remain unnoticed until a larger injury occurs, while in other cases, the symptoms may be more painful and obvious. The following are common stress fracture symptoms. Each person’s body reacts differently to trauma, so it is important to keep in mind that not all of these may be present:

  • Swelling
  • Pain
  • Tenderness
  • Increased swelling with activity
  • Continued pain in workouts
  • Earlier onset of pain in workouts

Stress fracture symptoms can go relatively unnoticed in a person and may become known only after a bone has broken completely or another injury has occurred. If you think you might have a stress fracture, it is important to see an orthopaedic surgeon who can diagnose you and help prevent further injury.

Causes

There are a few causes of stress fractures:

  • Rapid increase in activity – When a person increases his/her activity level quickly, the body does not have time to recover. More and more activity places strain on the muscles surrounding the bones and on the bones themselves and can cause stress fractures.
  • Impact on a new surface – If a person is used to running or walking on a specific surface, then switches to a harder surface, the bones absorb more shock. If the bones are not used to this, eventually it can cause them to develop a stress fracture.
  • Incorrect equipment – If a person switches the type of shoes worn, or never wears shoes to support the right areas, this adds stress, wear and tear on the bones and increases the risk of stress fracture.
  • Cigarette smoking
  • Inadequate nutrition
  • Steroid use

Types

Stress fractures can occur in many parts of the skeleton:

  • Sacral – This type of stress fracture occurs in the lowest part of the spine. 
  • Pubic – This stress fracture occurs in the pubic bone, often resulting in the patient experiencing groin pain.
  • Femoral neck – This fracture is in the upper part of the thighbone, at the hip.
  • Tibial –  The lower leg, below the knee
  • Foot and ankle – This type occurs sometimes from increased running or walking.

The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute treats stress fractures as well as a broad range of conditions that affect the bones.

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