Stress fractures of the leg are much more common in females than males and typically occur along the tibial bone, although they may also affect the fibula. The female’s anatomical structure slightly predisposes them to leg stress especially those with wider hips, an increased in knock knee position, and feet/arches that collapse inward (hyper pronation). Stress fractures are also more common in those who walk/run with their feet pointed outward. In all these instances, the muscles which are attached to the tibia leg bone pull downward as the foot and arch strike the ground. Pulling of the muscles from the leg bone may initially cause a feeling of shin splints (pain up and down the shin); however, repetitive microtrauma may cause a small fracture to the bone. Diagnosis is often made on careful clinical examination by palpating the areas of inflammation, thickened tissues, and localized swelling. X-rays may not be diagnostic for 10 to 14 days until there is a build up of healing calcium.
A careful biomechanical examination of one’s leg structure is performed in our office to help determine the underlying cause of malalignment or muscle imbalance which may have lead to the increased stress. Typically, we fabricate flexible temporary orthotics for each patient in our office to enable them to return to activity quickly. This may then be followed by custom orthotic devices. The use of orthotics is discussed in a separate section of this website. Orthotics will help to rebalance one’s foot and leg structure thereby reducing stress to the legs. Sometimes, patients present with orthotics yet have previously sustained a stress fracture. Often times, the orthotics are found to be inadequate for them. Patients must be reminded that our orthotics are semi flexible, shock absorbing and have a full length sports extension wedge to stop hyperpronation at push-off. All these are essential for those involved in running, jumping, and pivoting sports.
Other causes of stress fractures include those with metabolic disorders such as lack of calcium and hormonal imbalances. These issues may be detected by a blood test and/or other screening methods and a referral to one’s primary care physician or specialist may be necessary. There are a multitude of less common causes of stress fractures but by a careful history and thorough examination, the source of the hidden cause of this injury should be detected in our office. Should you or anyone you know suffer a leg stress fracture, please contact our office so for a detailed exam and specialized treatment.
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Written by Richard T. Braver, DPM, FACFAS