A stress fracture is a small, thin break in a bone which occurs due to repetitive activities which the bone has not been able to adapt to. Stress fractures are most often seen in the weight bearing bones of the lower extremity, especially the metatarsals, calcaneus (heel bone), tibia, and fibula. Stress fractures can occur with any repetitive activity but are typically seen in runners, dancers, and sports which involve a lot of jumping.

SYMPTOMS

A stress fracture can often go unidentified as initially the pain may be very mild and may not limit activity. Pain with stress fractures tends to worsen with time and is often felt directly in the area of the fracture. Pain tends to be worse with activity and is relieved with rest. People may also report swelling in the area of the fracture as well as a deep, aching pain. If left untreated, it is possible for a stress fracture to grow larger and become displaced.

DIAGNOSIS

Stress fractures are diagnosed through physical examination and diagnostic imaging. If the fracture is small enough it may not be able to be identified through an X-ray. Bone scans or an MRI are more commonly used to identify the break with an MRI being the ideal choice as it is more accurate and will show bone changes with more definition. Depending on age and activity level, the treating doctor may recommend a bone density scan to rule out osteopenia or osteoporosis.

TREATMENT

Once diagnosed with a stress fracture, the initial treatment is to stop activity and modify weight bearing. Patients may be given a walking boot if the fracture is located in their foot or ankle and may also be advised to use crutches in order to decrease the amount of force going through the fracture site. Surgery for a stress fracture is rare but may be necessary if the fracture becomes displaced or if the bone does not heal as expected. Doctors will also often recommend their patients take vitamin D and calcium supplements if they have signs of lower bone density.

PHYSICAL THERAPY

While a stress fracture is healing, an orthopedist may refer the patient to physical therapy for management of their symptoms and to work on gradually returning back to activity. It is important to respect the healing process of the fractured bone and to limit high impact activities. Physical therapy will primarily focus on progressive resistive exercise in order to stimulate bone healing and to improve bone density. When cleared to resume impact activity, PT will also perform movement and running assessments in order to reduce the risk of re-injury.