What is a Stress Fracture? - Definition, Symptoms & Treatment

Instructor: Nadine James

Nadine has taught nursing for 12 years and has a PhD in Nursing research

In this lesson you will learn about stress fractures. Included will be the definition, symptoms, and treatment of the fracture. Also, the tests and assessments to diagnose the injury will be discussed.

Definition and Epidemiology

A stress fracture is a tiny crack in the bone and is classified as an overuse injury of the bone. The stress fracture can occur in any bone in the body. Usually, the bones of the leg and foot are prone to this injury because they bear the weight of the whole body.

It happens because the muscles are overused and become tired. Suddenly, the muscle cannot absorb the shock of the repetitive use. Eventually, the muscle transfers the shock to the bone and this causes a tiny crack in the bone.

The tiny fracture can also happen when the bone is weakened such as in osteoporosis. Normally the bone is solid, but with osteoporosis, the bone has a look of webbing on an X-ray. Even everyday use may cause stress fractures in these individuals.

How prevalent are stress fractures? Estimates in the United States are between 5-30%. They are 1 of the 5 most reported injuries by people who run for fitness and account for half of the injuries in the military.

White individuals report higher incidence of stress fracture. This is thought to be because black individuals have higher bone density. Most of the reported scientific studies indicate that females have higher risk of stress fracture than males. Again, this may be due to lower bone density in females. Stress fracture risk also increases with age but should not be overlooked in the child whose bones are still growing.

Symptoms and Types

The most frequent symptom is pain with activity. As the activity is continued, the pain gets worse. The pain may subside with rest for a while. As the injury continues to worsen, the pain may not go away even when the activity is stopped. Eventually, night time is reported as the time when the pain is the most severe.

Here's an example: You have a friend who calls you from the track. You know he is training for a 5K run. He started the training just last week and yesterday said he began to have pain in his left foot. As a friend, you told him they should slow down with the training, but he didn't want to slow down. Now what?

You suspect a stress fracture in your friend's foot or ankle. You tell him to stop running and rest because you know that ignoring the pain can have serious consequences. The bone may break completely! You run over and apply an ice pack and elevate the foot above the level of the heart. You tell your friend to not put weight on the foot until after he sees a doctor.

It's important to note the difference between this and a regular broken bone. A long-bone fracture produces localized sharp pain while pain from a stress fracture is usually more rambling and the pain is harder to describe.

Tests

If you have a stress fracture, you'll probably come limping into the doctor's office, complaining of pain in the affected area. The first test a doctor will perform is a visual assessment. At first glance, the doctor may see redness in the area and swelling, but will probably want to run some more tests. Most of the time, the doctor will also perform an X-ray to make sure there is no broken bone.

The X-ray performed will indicate if the bone is fractured but may not indicate a stress fracture, especially early in the process. Some reports show that only 15% of all first X-rayed stress fractures are seen.

CT scans and MRIs may show the stress fracture early, but because the tests are expensive they're not typically done. Rather, the physician will typically use the assessment and the X-ray to complete a diagnosis of stress fracture.

Treatment

Once diagnosed, the doctor will develop a treatment plan that is tailored to the individual and the type of injury. Activity reduction and rest are included in most treatment plans. The plan can take from 4-12 weeks of rest to heal the injury. Occasionally the doctor will brace or even cast the affected bone to promote healing.

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