Exercising too intensely can lead to a fatigue (or stress) fracture of the foot, knee, heel, wrist, characterized by pain on exertion, or even at rest. What is the treatement ? What test to diagnose it? What is the healing time?
Foot, ankle, knee…The number of stress fractures has considerably increased during deconfinement, after a significant drop in physical activity during the Covid-19 pandemic. As its name suggests, it is a fracture related to bone fatigue which, weakened by repeated and/or too intense movements, can end up fracturing. This type of fracture is common in sports who makes running or of athleticismbut also in women and men who engage in intense physical activity, without adopting an adequate diet. What are the symptoms of a stress fracture? THE exams to diagnose it? How much healing time for a stress fracture? What treatments to treat it? Explanations and advice from Dr. Alexandre Parpaleix, radiologist.
Definition: what is a stress fracture?
“A stress fracture, also called a stress fractureis a term given to a bone fracture appeared on a healthy bone, in a very specific context and apart from a classic trauma“, defines Dr Alexandre Parpaleix, radiologist, from the outset. Repeated and/or unusual overuse, certain lifestyles and treatments induce loss of bone density which weaken the bone and eventually break. This fracture is often said “incomplete” in the sense that it does not separate the bone segment into two or more fragments as is the case in a classic fracture.
Feet, ankle, knee… where are stress fractures?
Stress fractures can involve any bone, but are more frequently localized to support areas and therefore to the lower limbs:
- At the level of the leg: the tibia mainly, but also more rarely the fibula.
- At the level of the bones of the foot: metatarsalsbone of tarsus And Bank (heel) for example.
- At the level of the pelvis (sacrum).
- The level of femur.
- The level of knee (patella).
- Exceptionally, at the level of elbow and wrist.
What are the symptoms of a stress fracture?
Stress fracture leads to mechanical pain initially linked to the activity (walking, support, sporting movements, etc.) and which cease when it stops. It may exist tenderness to palpation or percussion of the fractured bone. In a second time, the pains are present continuouslyeven at rest when the person is not supported.
How long does it take for a stress fracture to heal?
The rest time varies from person to person. We consider that the bone is consolidated when there is no longer any pain. “Overall, depending on the anatomical regions and the physiology of the patient, it is necessary to between 4 and 8 weeks time to truly repair the fracture and consider the gradual resumption of sport“, estimates our interlocutor. In the absence of treatment, the fracture of stress can persist for several months.
What causes a stress fracture?
Risk factors for a stress fracture:
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“Unlike a classic fracture, a stress fracture is a lesion that occurs without any particular trauma (hit, fall, shock, etc.). She intervenes on healthy bone whose bone density is reduced by various mechanisms and risk factors. To simplify things, healthy bone is an invisible balance on our scale, because it is on a cellular scale, between bone formation and bone destruction. In some cases and apart from any underlying pathology, this balance is disturbed in favor of bone demineralization. Fractures can therefore appear on this bone whose microarchitecture is weakened“, explains the radiologist. Stress fractures are therefore very common in cases of fragility of bone density, especially in cases of:
- Sudden change in physical activity (overtraining, overuse of the skeleton, too intense resumption of sport after a long time without doing sport, etc.).
- low BMI or dehydration.
- Sequelae of Covid.
- taking certain medications such as corticosteroids.
When and who to consult for a stress fracture?
In the event of chronic throbbing pain, which intensifies during an effort and which persists over time, you should consult his general practitioner who will prescribe the necessary examinations and can refer to specialists.
What test can diagnose a stress fracture?
“The diagnosis is all the more complex as patients tend to consult pain from a distance and the context is often not very informative.asks the radiologist straight away. This is why you should always consult a doctor in case of pain to allow appropriate care.“The diagnosis is based on a clinical examinationbut must be confirmed by radiological examination.
► The first-line examination is bone x-ray which may show either signs of fracture or indirect signs of consolidation of the bone (the bone that has repaired itself). When the lesion is too thin, conventional radiography cannot detect it. X-rays are also used to eliminate other pathologies that could be responsible for pain. “There are a number of bone lesions that go unnoticed on conventional X-rays (lesions that are too fine or difficult to see with the naked eye). Grace to Artificial Intelligence toolswe have access to the micro-architecture of the bone – which the human eye is not able to see – and we will maximize the doctor’s and radiologist’s chances of detecting extremely subtle lesions“, details the radiologist.
► If the fracture is invisible during the x-ray, we perform an MRI which makes it possible to clearly detect the bone lesion and theassociated edema (inflammatory reaction).
► In some cases, a bone scan can make it possible to highlight bone abnormalitiesbut it is not a first-line examination.
If left untreated, the stress fracture may persist for several months.
The stress fracture heals on its own. “There is no real treatment except complete rest, to allow time for the bone to repair itself.“, indicates the radiologist. It is thus necessary to limit the movements and to avoid exerting a pressure on the lesion. The use of crutches can help avoid weight bearing for a few days. Neither cast nor surgery is usually recommended. “Limiting activity allows you to take a step forward. However, it must be short to avoid promoting bone demineralization and thus maintaining a vicious circle. It is also a privileged moment to take charge of all the other risk factors that may be added. In this context, physiotherapy may be beneficial to allow a controlled, adapted and gradual resumption of physical activity“, he continues.
► Always have a physical activity adapted to his physical condition.
► In a post-lockdown context, the resumption of physical activity must be done gradually, starting with short sessions and less intensive.
► Choose shoes suitable for sportwhich absorb shocks well and with good quality soles, especially for sports that require support such as jogging.
► Stay hydrated before, during and after the session.
Thanks to Dr. Alexandre Parpaleix, radiologist, doctor in neurosciences and co-founder of Milvue, a French startup specializing in artificial intelligence in radiology and who has developed a specific AI for analyzing x-rays.