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(607NewsNow) — Repetitive and excessive stress on a bone can cause stress fractures, most often involving the leg or foot. These are common injuries that many patients overlook until the injury worsens and causes significant pain and swelling. Early intervention is the best method to avoid surgery.
Stress fractures usually occur when physical activity or exercise strain a patient’s leg or foot bones beyond their strength. Even moderate activity can cause a stress fracture when patients have not maintained their bone strength through exercise or have a vitamin D deficiency.
Many Finger Lakes residents are at risk for stress fractures after a long winter of inactivity and reduced sunlight, which allows our skin to produce vitamin D. That risk can be reduced by easing back into physical activity, including non-impact exercises, and talking with your primary physician about using a vitamin D supplement. Patients with eating disorders or conditions resulting in malabsorption of vitamin D, bone loss, or osteoporosis are at greater risk for stress fractures and should consult with their physicians on treatment.
What are the symptoms of a stress fracture?
Initially, pain and swelling at the fracture site may not be noticed. The pain usually increases over time and gets worse with physical activity. Stress fractures most commonly affect the leg — often the tibia, or shinbone, or the foot — specifically the navicular bone between the ankle and the midfoot, and the metatarsals behind the toes. The fifth metatarsal on the outside of the foot is a common location for a stress fracture.
Who is at risk for a stress fracture?
Women have a slightly higher risk than men do. Athletes, military recruits training with heavy backpacks, and those taking part in high-impact activities such as gymnastics, basketball, volleyball, soccer, or who run over 25 miles per week, are more likely to get stress fractures. Rapidly increasing physical activity or an exercise program can also cause stress fractures. People who have flat feet or high, rigid arches are more likely to develop stress fractures.
Having had one or more stress fractures increases the risk of having more. Conditions such as osteoporosis can weaken bones and make it easier for stress fractures to occur. Smoking, having over 10 alcoholic drinks per week and lack of exercise are also risk factors.
How is it diagnosed?
Sometimes a diagnosis is made from a medical history and physical exam, but imaging tests are often needed. Those include:
§ X-ray. This is a good initial test for stress fractures, but it does not catch all stress fractures, especially early fractures.
§ Magnetic resonance imaging (MRI). An MRI not only shows stress fractures but can show stress reactions, which are essentially pre-stress fractures.
§ Bone scan. The test uses a small dose of radioactive material given through an intravenous line. The radioactive substance is absorbed by areas where bones are being repaired and shows up on the scan image as a bright white spot. This test may be used for patients who cannot get an MRI.
How is a stress fracture treated?
Eliminating the activities that caused the injury and prevent it from healing are essential. Patients may need crutches, casts, walking boots or similar aids for several weeks to rest the bone and let it heal. Addressing vitamin D deficiency is also important.
The earlier you visit your doctor about a stress fracture, the sooner you will return to your activities. Most stress fractures heal without problems, but some fractures, such as those in the tibia, may require surgery to heal.
Alec Macaulay, MD, is an orthopedic surgeon with Cayuga Orthopedics and serves on the medical staff of Cayuga Medical Center. Dr. Macaulay received his medical degree from Columbia University College of Physicians and Surgeons. He completed his residency and foot and ankle surgery fellowship training from Harvard University. His clinical interests include both the surgical and non-surgical treatment of athletic injuries, arthritic conditions, and musculoskeletal trauma. He specializes in surgery of the knee, ankle and foot. Dr. Macaulay sees patients at Cayuga Orthopedics, 16 Brentwood Drive, Suite A in Ithaca and in Cortland at 1122 Commons Ave. For an appointment call (607) 272-7000.