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Stress Fractures, Sports Medicine

Nicholas M. Cardinale, MD Reviewed 04/2019
 


BASICS

A stress fracture (SF) is damage to bone caused by repetitive loading that exceeds healing capacity. SF injury can range from a mild periosteal reaction to a displaced fracture. SFs are grouped...

DIAGNOSIS

HISTORY

  • Insidious local pain from repetitive activity

  • Worse with continued activity

  • Pain at rest (e.g., night pain)

  • Assess risk factors and training history (miles per week, intensity, frequency...

TREATMENT

GENERAL MEASURES

  • Stop the offending activity.

  • Use a cast, pneumatic boot, rigid sole shoe, or crutches to ensure pain-free relative rest.

  • A compression boot for tibial SFs leads to earlier retu...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Athletes are typically followed every 2 to 4 wk to assess for symptomatic improvement and allow a gradual increase in weight-bearing. A progressive jogging protoc...

REFERENCES

1
DeFroda SF, Cameron KL, Posner M, et al. Bone stress injuries in the military: diagnosis, management, and prevention. Am J Orthop (Belle Mead NJ).  2017;46(4):176–183.
2
McInnis KC, Ram...

ADDITIONAL READING

  • Reiman MP, Mather RCIII, Cook CE. Physical examination tests for hip dysfunction and injury. Br J Sports Med.  2015;49(6):357–361.

  • Varley I, Greeves JP. Functional polymorphisms...

CLINICAL PEARLS

  • Diagnosis is based on high index of suspicion, risk factors, and clinical findings. Negative x-rays do not exclude SFs.

  • Obtain urgent advanced imaging in patients with antalgic gait and...

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