A bony stress reaction is an overuse injury to the internal structure of the bone. It occurs when the muscles around the bone become too tired and lose the ability to absorb the added pressure and tension from the overload of work or activity, therefore transferring that load onto the bone instead. Stress reactions and stress fractures are part of a continuum. A stress reaction is a precursor to a stress fracture and presents as swelling within the bone. The bone is breaking down and becoming weaker but no fracture- or break- has occurred yet. When the added stress becomes too great for the bone to handle a small crack is created called a stress fracture. Weight-bearing bones of the foot, ankle, and lower leg are exceptionally vulnerable to stress reactions or stress fractures due to the constant load being placed on them while walking or even just standing.
Symptoms
Pain with activity that subsides or diminishes at rest
Pain that occurs and increases during normal, daily activities that was not there before
Swelling in the area of the pain
Tenderness to touch at the site of the fracture
Pin pointed pain at fracture site
Possible bruising
Causes
Increased intensity, duration, or volume of activity too quickly
High impact activity or a highly repetitive impact activity
Unfamiliar surface or a change in activity surface
Improper equipment or shoes
Improper technique being used placing extreme stress where it should not be placed
Bone insufficiency
Poor or improper conditioning prior to sport or activity
Risk Factors
Highly repetitive impact sports such as running, tennis, gymnastics, basketball
Not allowing sufficient rest in between workouts
Certain nutritional deficiencies such as a lack of Vitamin D
Osteoporosis
Prevention
Gradually and progressively introducing activity
Cross training and alternating activity
Give body adequate rest time between sessions
Maintain healthy diet with plenty of calcium and vitamin D
Proper equipment use and proper shoes for activity
Stop if pain presents itself (it is important to identify early before it progresses)
Diagnosis
Physician will do a manual evaluation
X-rays are taken to see if any fracture can be seen. However, stress fractures sometimes are not seen on regular X-rays and a CT, MRI, or bone scan must be done.
Treatment Options
Non-surgical:
Rest- especially from the activity that caused injury
Orthotics/brace/boot may be used to take pressure off of bone and to help with weight-bearing
Physical therapy or occupational therapy to encourage pain free activity/movement
Surgical:
Internal fixation with rods,plates, or screws may be necessary if the fracture becomes severe or lesions will not heal
