Bony Stress Reactions/Stress Fractures

A bony stress reaction is an overuse injury to the internal structure of the bone. It occurs when the muscles around the bone become too tired and lose the ability to absorb the added pressure and tension from the overload of work or activity, therefore transferring that load onto the bone instead. Stress reactions and stress fractures are part of a continuum. A stress reaction is a precursor to a stress fracture and presents as swelling within the bone. The bone is breaking down and becoming weaker but no fracture- or break- has occurred yet. When the added stress becomes too great for the bone to handle a small crack is created called a stress fracture. Weight-bearing bones of the foot, ankle, and lower leg are exceptionally vulnerable to stress reactions or stress fractures due to the constant load being placed on them while walking or even just standing. 

 

Symptoms

• Pain with activity that subsides or diminishes at rest

• Pain that occurs and increases during normal, daily activities that was not there before

• Swelling in the area of the pain

• Tenderness to touch at the site of the fracture

• Pin pointed pain at fracture site

• Possible bruising

 

Causes

• Increased intensity, duration, or volume of activity too quickly

• High impact activity or a highly repetitive impact activity

• Unfamiliar surface or a change in activity surface

• Improper equipment or shoes

• Improper technique being used placing extreme stress where it should not be placed

• Bone insufficiency

• Poor or improper conditioning prior to sport or activity

 

Risk Factors

• Highly repetitive impact sports such as running, tennis, gymnastics, basketball

• Not allowing sufficient rest in between workouts

• Certain nutritional deficiencies such as a lack of Vitamin D

• Osteoporosis

 

Prevention

• Gradually and progressively introducing activity

• Cross training and alternating activity

• Give body adequate rest time between sessions

• Maintain healthy diet with plenty of calcium and vitamin D

• Proper equipment use and proper shoes for activity

• Stop if pain presents itself (it is important to identify early before it progresses)

 

Diagnosis

• Physician will do a manual evaluation

• X-rays are taken to see if any fracture can be seen. However, stress fractures sometimes are not seen on regular X-rays and a CT, MRI, or bone scan must be done.

 

Treatment Options

Non-surgical:

• Rest- especially from the activity that caused injury

• Orthotics/brace/boot may be used to take pressure off of bone and to help with weight-bearing

• Physical therapy or occupational therapy to encourage pain free activity/movement

 

Surgical: 

• Internal fixation with rods,plates, or screws may be necessary if the fracture becomes severe or lesions will not heal