Dear GeezerJock Doc: I was recently told I had developed a stress fracture. Any advice?

The GeezerJock Doc responds: A stress fracture is a reaction of the bone to abnormal forces. This phenomenon was described as a "march fracture" in military recruits. New recruits were repeatedly made to march long distances with  little time for acclimatizing to these new routines. Many recruits complained of foot pain, and x-rays revealed stress fractures.

Stress fractures are different from a fracture that is a result of a fall or other trauma. Stress fractures occur over a definitive period of time and are caused by overuse.  One theory as to etiology is that with repetitive overuse, muscles and supporting structures begin to fatigue and transfer more of the load to the bones.

Most stress fractures involve the lower extremities: metatarsal and the heel bones in the foot, tibia and fibula in the lower leg, and hip or femur in the upper leg.

The most common presenting complaints are pain and swelling. Athletes will note a dull or sharp pain that is initially activity related. Swelling may or may not be present. Usually the athlete will rest for a few days only to have the pain return upon resumption of the sport.

Initial evaluation by a physician will generally reveal point tenderness and swelling. Often the initial x-rays are interpreted as normal. The x-ray changes can take up to three weeks to appear. The diagnosis in this case is often purely clinical. Further investigation can involve MRIs, bone scans or CAT scans. All of these diagnostic aids are more sensitive and can make  the definitive diagnosis earlier.

Treatment is variable depending on the location of the stress fracture. Stress fractures in the foot or fibula are often treated with rest and some form of immobilization.
The vast majority of these heal in four to eight weeks. Tibial and hip stress fractures have a higher likelihood of needing an operative intervention and should definitively be treated by an orthopedic surgeon.