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Stress Fractures

Bones are constantly changing. They respond to the work that is being placed on them. Bones also constantly repair themselves by replacing cells. Bones will accumulate a high level of calcium when they are intensely being used. When the bones are not frequently used, less calcium is produced. When too much stress is being placed on a bone impeding its ability to repair itself, cracks can start showing in the bone structure .

A stress fractures is a crack that happens in the bone because of overuse. They are most common in high impact sports such as baseball, or distance running. Other activities requiring running and jumping or repetitive movements such as cricket, or rowing. They occur most often on the weight-bearing bones of the leg (the metatarsal bones).

Causes of Stress Fractures and symptoms

The most frequent cause of stress fractures has usually been considered to be overuse, as in training too much or not mixing adequate rest into a workout plan. However, orthopedic surgeons generally feel that the main cause of stress fractures in runners and triathletes is a change in activity — e.g. heavier training, new shoes, taking on a different sports, etc.  This means that as you adjust and escalate your training, it is very important to be gradual and make sure that you assess how you are feeling before you layer more activity in. Cases have been recorded where patient reported stress fractures after having hiked while on vacation for a considerable amount of time. Beside overuse some sports that requires a lot of running and jumping can result in stress fractures and also patient suffering from osteoporosis are at risk. Any bones of the ankles or feet can be affected and particularly weak or soft bones. It develops often in people starting a new exercise or force abruptly the intensity of the workout. Another cause of stress fractures is anatomical abnormalities such as fallen arches which distributes stress unequally to the feet. Stress fractures therefore can result because of:

  • Sudden change in activity
  • Sports requiring lots of running or jumping
  • fragile and soft bones
  • Osteoporosis conditions
  • Anatomical abnormalities

The symptom of stress fractures consist of dull pain near the site of the fracture. Swelling can also be noticed on the location and the pain becomes worst when standing, walking, or exercising. To diagnose stress fractures an examination of the foot is undertaken. Most of the times, an X-ray is performed. Stress fractures often tend to recur. Statistic indicate that about 60% of people suffering from stress fractures have had the same problem previously.

Note that sometimes another issue might mimic a stress fracture, so you need to pay attention to symptoms and know your body.  For example, shin splints can often resemble a lower-leg stress fracture, only the pain is a bit more dull and generalized.  When you are the one with the pain, though, it seems anything but dull — just note exactly where the pain is coming from, and what activities tend to trigger it.

Treatment of Stress Fractures

Most often the treatment would require stopping any activity that may have been the result of the stress fracture. Rest is then recommended for a certain period. Other exercises can be undertaken but with reduced intensity. Ice should be used on the swollen surface for at least 24-48 hours and appropriate rest for at least six to eight weeks from the activity that has caused the stress fracture. Pain killer like paracetamol may be prescribed by a doctor, something that has been found to have other positive benefits for runners as well — but we are not advocating starting any type of drug regimen unless suggested directly by your personal physician.

A splint or cast can also be recommended depending on which bone is involved, or special shoe wear. Vitamin D and Calcium also are prescribed.
In most cases the above measure should heal the stress structure. A case known as nonunion (when the bone fails to heal) may require surgery. This involves the placement of screws to secure the bone. It sometimes also involves placing fresh bone in the area. Nonunion is the most common complication that can occur with Stress Structures. Another complication is malunion. In the case of malunion, the bone heals but in an abnormal position. Yet another complication is recurrent fractures which often occurs in cases of osteoporosis.

Prevention of Stress Fractures

There are a couple of measures that can be undertaken to prevent stress fractures

  • Use the correct footwear depending on the exercise being undertaken
  • Begin any new exercise slowly resting when necessary
  • Before running or walking, warm up by stretching and walking
  • If you run in a colder climate, be sure you have the right cold weather running clothing for your situation.  Stress fractures and foot injuries tend to increase in the cold.
  • Use good shoes that are tailored to your foot and gait — if you have never been fitted by a true running shoe store, it might be worth the time
  • Strengthen the muscles of the calf by doing weight training, bodyweight exercises, or yoga
  • Rest properly after intense exercise.  Preferably, never run two days in a row, especially if your workouts have intensity.

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