A stress fracture is a small injury or a minor crack in bone arising as a result of overuse or repetitive trauma. 1 Stress fractures are a common complaint in military recruits and athletes, especially those who do long-distance running. 2 It occurs because the exhausted muscle can no longer bear the shock from overexertion and the stress is directed to the bone. The fracture causes intense pain in the affected bone, which is aggravated by activity and relieved by rest.
A stress fracture can occur in any bone of the body that is overused and is under sheer stress. 3
Stress fractures, however, are commonly seen in the bones of the lower extremities, 4, particularly tibia. The stress fractures in the foot bones also occur frequently, as a result of weight-bearing activities and impact.
Causes of a stress fracture:
Though stress is the major cause of the bone fracture, other factors contribute too. These are: 5
Above mentioned are factors that are influenced by the external environment and can be modified, hence known as extrinsic factors. There are some non-modifiable or intrinsic factors too that can increase the risk of stress fractures. 5 These include:
Types of a stress fracture:
Stress fractures frequently occur in the bones of the lower extremity, because they bear the weight of the whole body and are repetitively exposed to the stress. Depending on the bone involved stress fractures can be of following types: 5
Metatarsal stress fractures:
This type of fracture usually occurs in ballet dancers, gymnasts and hikers where there is constant pressure on the metatarsal bones, which are long bones connecting ankle and toes. Resultantly, the foot becomes painful and swollen in the middle or front region.
Navicular stress fracture:
The navicular bone is present just above the heel and is one of the tarsal bones. It fractures commonly in individual who play high impact sports such as jumping, hurdling, soccer and basketball. Navicular bone experiences dual stress, that is, above from the body's weight and below from the ground.
Tibia stress fracture:
The shin of the lower limb comprises of the two thin bones – the larger tibia and relatively smaller fibula. It bears the maximum stress and fracture when the foot is pounded repeatedly on a hard surface. The pain of tibial stress fracture is experienced in the shins. This type of fracture is common in runners, gymnast and volley ballplayers.
Ribs stress fracture:
Ribs are 12 horizontal bones located on each side of chest forming a cage-like structure with other bones. The first rib is comparatively delicate as many vessels traverse it; therefore, it is more prone to injury. People who play baseball, rowing, dance and windsurfing – all sports requiring vigorous movement of shoulder – are more likely to have a rib stress fracture.
Hip stress fracture:
Hip stress fracture, commonly seen in a long-distance runner, mid-impact sports athletes and military recruits, results in an injury to the ball of the hip joint. This produces intense aching pain in the groin region, which worsens as the person lie down or run and hops. Sometimes hip fractures may not heal properly and the fractured bones misaligned. This situation is dangerous as the blood supply of the hip bone compromises – a condition called osteonecrosis.
Stress fracture treatment:
The treatment of stress fracture is essential to prevent future complications. A neglected stress fracture may give rise to arthritis, misaligned bone or more severe consequences requiring surgery. The general measures include taking appropriate rest and avoiding activities that further stresses the affected bones. It is necessary to consult the doctor for expert advice.
The medical treatment depends on the site of the fracture, extent of the injury and the symptoms it is producing. The doctor may suggest one of the following treatment options: 4,5