|ICD-10||M48.4 and M84.3|
|ICD-9||733.93, 733.94 and 733.95|
Stress (fatigue) fracture - This is a fracture caused by fatigue fracture of the bone due to repeated stress. Unlike a fracture caused by one strong blow, stress fractures are the result of accumulated microtrauma from cyclic loads below the maximum, for example, when running or jumping. In view of the features of the mechanism of occurrence, a fatigue fracture can be attributed to typical injuries caused by overload and overtraining.
Very small bone fragments and microcracks are characteristic of a fatigue fracture. Most often, this type of fracture occurs in the supporting bones, such as the tibia, metatarsal and scaphoid bones, in other words, in the bones of the lower leg and foot. Less common are fatigue fractures of the hip, pelvis, and sacrum.
Fatigue fractures are most often manifested by pain in the supporting bones, which intensifies during physical activity and exercise. The pain usually subsides during rest or may persist with more significant bone injury. Typically, the pain is localized on the bone or next to the bone with a characteristic common edema in this area. Tapping and palpating bones can cause symptoms.
Reasons [edit |
Causes of stress fractures.
The main cause of stress fractures is overtraining. A new or more intense training program leads to muscle fatigue. Muscles adsorb most of the axial load when running and jumping, but if they get tired, the load goes to the ligaments and bones. A bone has a certain margin of safety before a certain amount of time passes before it is completely exhausted. In this case, pain in the area of a future fracture usually appears long before it.
Another factor that increases the risk of stress fractures is the improper running and jumping technique. Violations of muscle balance, improper installation of the foot, bad shoes - all this additionally increases the load on the musculoskeletal system.
The third factor predisposing to a stress fracture is a congenital anomaly of the anatomical structure. Too low (flat feet) and too high (hollow foot) arch of the foot leads to inadequate load distribution.
Osteoporosis is another common cause of stress fractures. In everyday life, osteoporosis occurs almost exclusively in women after menopause. But women who are actively involved in sports and exhausting themselves with a diet are in the same position despite their young age. Many orthopedic surgeons even distinguish an “athletic female triad” of diseases: bulimia anorexia, amenorrhea, osteoporosis. These women have a very high frequency of stress fractures.
Diagnosis of stress fractures.
Radiography - very often does not reveal stress fractures, especially in the initial stages.
Bone Scan - A small dose of a radioactive drug is actively accumulated in damaged bone tissue. Highly sensitive method, but not excluding other types of pathology.
CT, MRI - often can detect changes in the bone long before the fracture itself occurs, which allows you to take measures to prevent it.
Stress fracture treatment.
In the vast majority of cases, the treatment of stress fractures is conservative. Gypsum immobilization for a period of 4-8 weeks, followed by physical therapy. In the acute period with severe pain, it is recommended to take NSAIDs, local cooling therapy. Training is resumed gradually, special attention is paid to training the strength and elasticity of muscles, muscle balance. Loads gradually increase over 6 months.
If therapy is ineffective, in cases where a stress fracture with a shift occurs, as well as in a situation when it is necessary to restore shape as soon as possible (professional athletes), surgical treatment may be required. Most often, bone or intraosseous osteosynthesis is used.
With timely and competent treatment, in most cases a complete recovery is observed. In 9 out of 10 cases, conservative treatment is successful and surgery is not required. To prevent stress fractures, it is important to observe the correct training and nutrition regimen, avoid overworking muscles, and gradually increase the amount of exercise.
Nikiforov Dmitry Alexandrovich
Specialist in foot and ankle surgery.
What is a fatigue (stress) fracture? This is an injury to the limbs that occurs as a result of repeated damage to bone tissue due to constant overvoltage. The disease manifests itself in the form of numerous microcracks on the bones of the arms and legs. May occur on the heel, tibia, metatarsal and scaphoid bones. According to statistics, no less often people go to the hospital with bruises of the hip, pelvis and sacrum. There is also a fracture of the rib due to overvoltage.
Not always the cause of the disease is intense sports loads. It can also appear in humans as a result of the development of a completely different disease (osteoporosis). Then a fatigue fracture can happen even with normal daily physical exertion.
Such a fracture is always accompanied by pain. If you do not start treatment for the disease in time, the disease will worsen and progress. And subsequently, doctors will be forced to resort to surgical intervention.
Stress fractures of the legs are dangerous because they can occur in a person of any age. Since the lower extremities of a person are subject to the most intense load, they often occur in the lower leg, and a fracture of the foot is also possible. Therefore, sports such as running, gymnastics and tennis are especially traumatic. There are a number of reasons for the development of the disease. Below these points are considered in detail.
- Violation of the technique of physical exercise. The risk of such a fracture grows at times if the person involved does not adhere to the basic rules for performing exercises and violates safety precautions. The most common violations include the incorrect distribution of the load on the feet. Such minor injuries as corns and joint inflammation overload the legs very much. Especially at risk of a fatigue fracture are novice athletes who cannot correctly calculate the frequency of exercise and the intensity of their load.
- Incorrect equipment. Incorrect selection of sportswear can also be attributed to the causes that cause the development of this disease. Very often, a stress fracture is the result of tight, narrow or too worn, worn shoes. The place where the training takes place plays an important role: the street, a shady court, an indoor gym. Changing the type of surface for exercise also leads to leg injury.
- Bone weakness. Fatigue fracture may result from weakening of bone tissue. This phenomenon occurs in a person as a result of another disease, intensive treatment with drugs, or in professional athletes as a side effect during active physical exertion. Weakness of bones most often occurs in women and is a consequence of malnutrition, menstrual irregularities.
Improper training surface and uncomfortable equipment can result in personal injury.
Symptoms of a leg fracture
A stress fracture is accompanied by pain during exercise. And this is the main sign of damage. Also the symptoms of this disease are:
- obstructed movement
- swelling of the damaged area,
- bone compaction
- bruising is possible
- palpation pain.
It is very important at the first sign of an injury to ensure the rest of the affected limb.
Suspected rib fracture? Be sure to apply a retaining bandage. In case of calcaneus fracture or metatarsal bone, raise your leg to the level of the heart and apply ice to the affected area.
Metatarsal bone and stress
According to studies, more than 50% of people who lead an active sports life receive repeated injuries and cracked bones. Stress consolidating fracture can occur among dancers, gymnasts, skaters, runners, as well as people who carry heavy loads over long distances. Most often, doctors fix a fracture of 2 metatarsal bones against stress.
Pain in the foot indicates head injury, which increases depending on the intensity of physical activity, and eventually begins to bother a person even at rest.
Factors causing a stress fracture of the metatarsal bone include a high arch of the foot and poor-quality shoes, which are not suitable for long-term sports. To fully restore the efficiency of the limbs, you should seek medical help.
Metatarsal bone under increased stress
The patient and his attending physician strive to fully restore the efficiency of the limbs. This is a complex and lengthy process. For example, in the case of a stress fracture of the tibia, treatment lasts up to 4 months. Doctors give their patients some advice.
- During rehabilitation, it is important to take a break in exercise. While the bone is fused (from 6 to 9 weeks), you should refrain from intense exertion and try not to step on your sore leg.
- It is equally important during this period to choose the right shoes. It should be orthopedic, this will help reduce the load on the damaged area. Use also orthopedic insoles. You can buy them in specialized stores, having consulted with your doctor in advance.
- Sometimes, for better fixation, doctors put gypsum on the sore leg. Do not give up this treatment method. Gypsum dressing will reduce the load on the diseased limb and accelerate the healing process.
Treatment of sacral fracture consists in prescribing pain medications to the patient by the doctor, since recovery is accompanied by very painful sensations. But non-steroidal anti-inflammatory should be taken with great care. Many doctors believe that these drugs can have a negative effect on the healing process. After the crack heals, and the patient can again lean painlessly on his leg, it is necessary to begin physiotherapeutic procedures that will help restore the functioning of the limb completely. Surgical treatment is resorted to when conservative methods have not been effective. Often with fatigue fractures, especially with a bruise of the head of the 3 metatarsal bone, doctors use special retainers (screws, knitting needles) that allow you to fasten all the small parts together.
Orthopedic insole is needed to restore the foot
The following tips will help you maintain your health and save you from fractures. First, eat right, be sure to include in your diet foods containing vitamins B and D, calcium. Secondly, plan your workouts correctly, increasing the load gradually and accustoming your body to this. Thirdly, do not forget that any physical exercises should be done only after a little warm-up and stretching.
People who are accustomed to lead an active lifestyle suffer especially hard, because they suddenly found themselves forced to slow down overnight.
Yes, the pathology in question is treated for a long time, but patients calmly return to their previous lifestyle and completely resume playing sports. Believe me, this disease can be defeated. The main thing is to follow the instructions of the attending physician and not violate the basic rules of the rehabilitation period. Take care of your health!
What to do before visiting a doctor
If you suspect a fracture during stress, you should not delay with a visit to a doctor. You can’t ignore the pain, it can have consequences in the form of serious bone damage, a long treatment and a long rehabilitation process.
Before visiting a doctor, do the following:
- Relaxation. Avoid weight loading on a damaged limb. If it is not possible to be at rest, care must be taken to relieve the injured leg or other part of the body as much as possible. For a leg, it is better to choose shoes with a thick elastic sole than a thin soft slipper.
- Ice. The faster you attach ice to an injured area, the less likely it is to develop edema. Apply ice or a thermal bag from a freezer wrapped in a towel for 20 minutes several times a day (3-4 times). Make sure that the ice does not directly touch the skin.
- Easy squeezing. To reduce or prevent swelling, you can apply a soft compressive dressing to the damaged area.
- Raising an injured limb. Try to sit or lie more often with your leg raised above heart level.
If the pain is severe, non-steroidal anti-inflammatory drugs like ibuprofen can reduce it.
If a stress fracture is suspected, rest should be provided to the affected limb.
The goal of the treatment is to alleviate pain and allow microcracks in the bone to be tightened with bone tissue. The main factor in the treatment is rest. It is impossible to recover completely without it. How long you have to be at rest depends on the severity of the injury. Nutrition plays a significant role during treatment and rehabilitation, since it affects the restoration of the body's strength as a whole.
The type of treatment depends on the severity of the injury and the location of its location. In 9 out of 10 cases, stress fractures are treated non-surgically.
Typically, treatment takes from 3-4 to 6-8 weeks. In complex cases, the treatment process can last up to three months. In addition to the above procedures (rest, ice, easy squeezing, lifting of the injured limb), as well as pain relieving and inflammation-stopping drugs, a doctor may recommend the use of crutches in order to remove the weight load from the leg in case of stress fracture of the lower extremities, until the pain will not disappear.
Fractures of tension of the 5th metatarsal bone (on the outside of the foot) of the cavernous, or oval, bones require more time for treatment. Gypsum may be used for fixation.
It is important that even in the absence of pain, the recovery process takes a long time, and therefore the risk of a new injury during exercise until it is completely cured remains high.
When mastering a new sport, gradualness is important. If this is running, 3-4 km to start with a small weekly increase in workloads.
Classes in a particular sport should be alternated with other "related" loads. For example, everyday running - with cycling, and weight training - with flexibility exercises.
It is necessary to use equipment of a good level of quality. By the way, running worn sneakers are an additional risk factor for getting a stress fracture.
If a pain or swelling occurs after a power load or as a result of a stroke, you should stop exercising or working and consult a doctor as soon as possible. It should be remembered that the continuation of training in this case leads to the fact that the treatment will take much longer.
A healthy diet is important, including a sufficient amount of foods rich in vitamin D and calcium. If necessary, the doctor will adjust the diet or prescribe the necessary additional medications.