Stress fractures

From a 2011 review in the journal American Family Physician:

Stress fractures are common injuries in athletes and military recruits. These typically affect lower extremities.

Symptoms of stress fractures

Stress fractures should be considered in patients who present with tenderness and/or edema after a recent increase in activity or repeated activity with limited rest.

The Barefoot Professor says barefoot running could minimize injuries although this approach is still experimental:



The differential diagnosis of stress fractures includes:

- tendinopathy
- compartment syndrome
- nerve or artery entrapment syndrome
- medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema

Diagnosis of stress fractures

When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after 2-3 weeks for greater accuracy.

If an urgent diagnosis is needed, triple-phase bone scintigraphy (bone scan) or magnetic resonance imaging (MRI) should be considered. Both modalities have a similar sensitivity, but MRI has greater specificity.

Treatment of stress fractures

Treatment of stress fractures consists of:

- activity modification - nonweight-bearing crutches if needed for pain relief
- analgesics
- pneumatic bracing

After the pain is resolved, patients may gradually increase their level of activity.

Surgical consultation may be appropriate for patients with:

- stress fractures in high-risk locations
- nonunion
- recurrent stress fractures

References:

Stress fractures: diagnosis, treatment, and prevention. Patel DS, Roth M, Kapil N. Am Fam Physician. 2011 Jan 1;83(1):39-46.

The Barefoot Professor says barefoot running could minimize injuries

Related reading:

The Barefoot Running Revolution - INFOGRAPHIC  http://goo.gl/7SUGs

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