| A stress fracture is a relatively common happening in | | | | type of surface used. |
| those who pursue sport and in military personnel who | | | | The important issues in being a risk for stress |
| march and train vigorously. Stress fractures are | | | | fracture are assumed to be the mechanical factors |
| mostly a feature of the lower limb bones but can be | | | | already mentioned but there may be many others |
| present in other areas of the body. The foot | | | | such as a lower intake of calories, a lower bone |
| metatarsals, the fibula and the tibia show the | | | | density or osteoporosis, female gender and |
| greatest frequency of this type of injury, with | | | | weakness of muscle. An increased incidence of stress |
| decreasing likelihood further up the leg. The | | | | fractures occurs in women who run a lot and these |
| application of repetitive strains to the bone at a level | | | | types of female athletes and others such as ballet |
| insufficient to cause immediate fracture can do so | | | | dancers may have menstrual cycle alterations, bone |
| over time as the activity proceeds. | | | | density loss and a typically low body weight so they |
| Increasing levels of pain reported in the part during | | | | can easily pursue their activity. |
| activities or exercise is the typical pattern of | | | | A stress fracture typically comes on without much |
| presentation, with a recent upturn in the intensity or | | | | warning and often without severe symptoms, during |
| frequency of training often reported. Treatment is | | | | an activity of repeated limb loading and without |
| uncomplicated and involves reducing the levels of | | | | trauma. Resting will usually abolish the pain which will |
| activity and in some cases by immobilisation. Most | | | | re-appear on performance of the weight bearing |
| heal without problems but there are some fractures | | | | activity again. Tenderness and swelling may be |
| which are much more likely to suffer from non-union | | | | apparent locally around the fracture site but it may |
| and for which surgical intervention may be required. | | | | be two to four weeks before a fracture can be |
| With orthopaedic surgery and formal immobilisation | | | | discernible on x-ray. Bone scanning may detect |
| these fractures will eventually heal. | | | | fractures much earlier, within 72 hours of the incident, |
| A stress fracture is likely to occur when bone is | | | | but are less clear as to the exact cause. |
| stressed many times in a similar manner, mostly | | | | The usual management of stress fractures is |
| without any particular individual event occurring. As | | | | conservative care, with the simplest and often the |
| repetitive compression and tension stresses are | | | | most effective method being a reduction in the |
| applied to the bone it sustains micro-damage which is | | | | responsible activity for 4 to 6 weeks. If there is a |
| repaired continually by the bone remodelling process. | | | | significant degree of pain on weight bearing then |
| If the bones sustain increased levels of microscopic | | | | they can be placed in a brace, a rigid walking boot or |
| injury they may not be able to repair themselves | | | | a below knee cast, with crutch use as required. |
| quickly enough by remodelling and strengthening, | | | | Orthoses in the shoes have been studied and found |
| leading inevitably to fracture. Increased physical | | | | to allow a reduction in fracture incidence of a certain |
| activity is a common factor in these injuries. | | | | amount, with shock absorbing insoles having less clear |
| Risk factors for this injury include the elevation in | | | | benefits but potential. |
| how often the stresses occur, the raising of the | | | | Stress fractures in most areas of the body heal |
| strength of those stresses or a change in the tissue | | | | without complications but in some cases healing can |
| areas to which the forces are being applied. If the | | | | be delayed or not occur at all, so-called non-union. |
| cross sectional area of bone which is being stressed | | | | Delayed or non-union is more common in certain |
| is smaller then this will cause an increase in the | | | | areas such as the bases of the second and fifth |
| stresses through that area, or the area can stay the | | | | metatarsals in the feet. Routine review of these |
| same and the force be increased. Jumping and | | | | fractures is important to assess whether further |
| running are activities with a higher risk along with | | | | immobilisation or internal fixation is needed. |
| changes in the way activities are performed or the | | | | |