Lower extremity stress fractures are quite common for sports athletes and those who exercise frequently. Around 50 percent of stress fractures occur in the fibula or tibia (the two lower leg bones). A stress fracture is a partial fracture caused by repetitive loading of the leg. Most of these fractures have a gradual onset unlike acute fracture where the bone is broken all the way through. Although painful, some people continue to participate in sports or exercise believing that the pain is related to a tendon or muscle injury rather than bone trauma. If left untreated, stress fractures can turn into acute fractures.
Who is at Risk for Stress Fractures?
Athletes who participate in sporting activities are at a high risk of lower extremity stress fractures. This is because of jumping and/or running that puts pressure on the bone. There is a higher incidence of leg stress fractures in distance runners and those who participate in track and field activities. Also, stress fractures of the fibula and/or tibia are seen in individuals who play volleyball, soccer, baseball, basketball, and softball. These fractures are related to the type of shoes the athlete wears, the amount of running and jumping done, and the surfaces the individuals compete on.
Classifications of Stress Fractures
Stress fractures of the lower extremities are either critical or noncritical. Noncritical fractures are usually located in the middle aspect of the fibula or tibia. They are considered noncritical because they heal within six to eight weeks. Critical stress fractures, however, do not heal well and have a non-union of the bone. Even after a recommended period of rest. These types of stress fractures may need to be surgically repaired to enhance healing. Critical stress fractures of the lower extremities are often related to poor local blood supply to the front aspect of the tibia.
Signs and Symptoms
Stress fractures of the lower extremities will cause an acute onset of pain, which usually occurs after a long training session. The patient will describe a throbbing or aching pain that is worse late at night after activity is over. The individual will not likely have a history of a single episode of injury and may complain of gradual pain over time. The person will also describe point tenderness over the stress fracture site.
The pain of a leg stress fracture often diminishes with rest but often returns with athletic activity. As the level of activity increases, the pain increases, which is especially true of weight-bearing activities like jumping, jogging, and running. Also, the individual may experience swelling over the fracture site that is associated with heat radiating to the front of the leg. The hot spot and point tender spot usually correspond.
If a patient experiences symptoms, the physician will take a detailed history and perform a physical examination. A stress fracture of the leg is not usually seen on a routine x-ray. For this reason, if the physician suspects this injury, he/she will order either an MRI or bone scan (or both).
There are many factors that contribute to a lower extremity fracture, such as sudden increase in training and/or mileage, training on hard surfaces, and insufficient shock absorption due to worn or poor quality shoes. Most stress fractures occur during the first few weeks of training. When weight-bearing bones are loaded beyond capacity, the bone becomes injured and breaks down.
The treatment of a lower extremity stress fracture depends on the classification. Non critical stress fractures respond well to a short period of rest with no weight-bearing for six to eight weeks. Ice and NSAIDS are often used to lessen inflammation and relieve pain. During the rest period, the athlete can only perform activities as allowed by the Los Angeles orthopedic specialist.
Dr. Raj at Orthopedic Institute in Los Angeles also offers stem cell procedures to help stress fractures heal. This can help individuals avoid surgery a significant portion of the time.
For nonunion, critical stress fractures, surgical intervention is often necessary. This may include use of one of the following procedures:
- Medullary nailing of the tibia
- Plates and screws
- Excision of the fracture area
- Bone transplantation
- Excision and drilling of the bone