Tibial Stress Fracture

Description:

A tibial stress fracture is a complete or incomplete fracture in the tibia caused by intense exercise or repetitive pressure on the extremity. The repetitive trauma to the bone exceeds its ability to heal and repair the injury, resulting in a breakdown of the bone, causing a stress or fatigue fracture. This is the most common bone to sustain a stress fracture in athletes. It can occur anywhere within the tibia.

Common Signs and Symptoms:

• Gradual onset of shin pain aggravated by exercise,
• Localized tenderness over the tibia (in front along the bone or in the calf), and
• Aggravated pain with walking and even at night.

Causes:

• Repetitive forces that exceed the bone’s capacity,
• Excessive training,
• Biomechanical factors, i.e. restricted pronation or ankle dorsiflexion,
• Usually occurs when there is an imbalance between bone injury and bone remodeling,
• Compromised bone density,
• High-arched, rigid foot-type, and
• Sudden changes in training regimen, equipment or intensity.

Preventative Measures:

• Appropriate warm-up and stretching before and after activity,
• Maintaining appropriate conditioning:
  • Calf muscle flexibility,
  • Muscular strength and endurance, and
  • Cardiovascular fitness.
• Proper footwear:
  • Replace running shoes every 500-800 kilometers.

Management:

• Ice and relative rest from the antagonizing activity, and
• Once pain free, gradual return to activity, i.e. swimming, cycling, water running, walk-to-run program.