Lower extremity sports injuries can range from overuse syndromes such as
tendonitis or plantar fasciitis to severe ankle sprains and fractures. One
of the most frustrating injuries that can occur in both novice and elite
athletes alike is a stress fracture.


Stress fractures are usually seen in people who participate in sports such
as running, tennis, basketball, and soccer where the foot and leg are
subjected to repetitive movement. Although stress fractures represent true
breaks in the bone, they are considered overuse injuries because they are
not caused by a single hit or twist, but rather a series of low-grade
stresses to a specific area of the bone.


Our bones adapt to increased stress by adding more bone cells and
essentially getting stronger. A stress fracture occurs when the forces
applied to a bone over a period of time exceed the ability of the bone to
repair itself. This results in small cracks forming in the bone that may
eventually result in a complete fracture.


The two most frequent causes of stress fractures in the lower extremity are
over-training and structural or biomechanical abnormalities of the foot and
leg. Over-training is usually the result of increasing the amount or
intensity of your sport too rapidly. This increase in activity over a short
period of time does not allow your bones to catch up with the increased
demands being placed on them. A change in playing or running surface can
have this same effect.


A less recognized cause of stress fractures is structural or biomechanical
abnormalities of the lower extremity. These should be suspected when a
person has not changed training workouts, but still suffers from recurring
stress fractures year after year. Often factors such as excessive
pronation, differences in leg length, ligament laxity (double jointedness),
and inflexibility can result in abnormal amounts of stress being placed on
specific areas of a bone, with the end result being the development of a
stress fracture. Women who do not menstruate regularly and individuals
receiving poor nutrition or suffering from eating disorders are also at
greater risk for developing stress fractures.


Symptoms of a stress fracture include a sharp pain that is felt whenever
stress is applied to the foot and leg such as in running or jumping. The
pain can usually be localized over a very small area of the bone. This
injury may develop slowly with the athlete ""trying to run through it,"" or
may seem to occur suddenly. The bones most often affected include the tibia
and fibula (leg bones), metatarsals, and the calcaneus (heel bone);
however, any bone in the foot and leg can incur this injury.


Early diagnosis of a stress fracture is important to prevent further
injury, Your sports medicine doctor will obtain a thorough history of the
injury and determine its precise location by physical examination. Although
x-rays will usually be taken of the area, in most cases a stress fracture
will not show up until healing has begun, usually in two to four weeks. The
most accurate method of diagnosing a stress fracture is with a bone scan. A
bone scan is a specialized imaging technique that can detect small
fractures in the bone within 48 hours after they occur. The earlier the
diagnosis of a stress fracture is made, the sooner efforts can be made to
heal this injury and return the individual to full activity.


The treatment of uncomplicated stress fractures involves refraining from
any activity that causes additional stress to be placed on the injury. This
includes running and jumping. Depending on the location of the fracture and
the nature of your every day activity, a cast is usually not necessary;
however, a brace or special shoe may be prescribed. These injuries usually
take at least six weeks to heal, which is the period of time needed for the
bone to mend enough so that re-injury does not occur. During this period of
healing, one can still keep fit by bicycling, swimming, running in a pool,
and weight training.


When the stress fracture is a result of a biomechanical or structural
abnormality, your sports medicine physician may recommend the use of foot
orthotics, stretching, or strengthening exercises to reduce the risk of
recurrence.

Stress fractures, although a fear of most fitness oriented people, usually
heal uneventfully once properly diagnosed. By attempting to ""run through""
this injury, however, the chance of prolonged healing time or more serious
injury is greatly increased.


By obtaining a thorough examination, your sports medicine physician can
help you identify factors that may put you at risk for this injury as well
as outline a plan of treatment to return you to full activity as soon as
possible.


Perry Julien, D.P.M., is a podiatrist specializing in the medical and
surgical treatment of foot and ankle problems at the Atlanta Foot and Ankle
Center in Atlanta, GA.