A fatigue (or stress) fracture is a small, incomplete fracture that causes pain during exercise, or even at rest.
Foot, ankle, knee… As its name suggests, it is a fracture linked 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 athleticismbut also in women and men who engage in intense physical activity, without adopting an adequate diet. What are the symptoms a stress fracture? THE exams to diagnose it? How much healing time for a stress fracture? What treatments to treat her? Explanations and advice from Dr Alexandre Parpaleix, radiologist.
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 outside of a classic trauma“, immediately defines Dr Alexandre Parpaleix, radiologist. 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 located?
Stress fractures can affect all bones, but are more frequently localized to the support areas and therefore to the lower limbs:
- At the leg level: the tibia mainly, but also more rarely fibula.
- At the level of the bones of the foot: metatarsalsbone of tarsus And Bank (heel) for example.
- At the pelvis level (sacrum).
- The level of femur.
- The level of knee (kneecap).
- Exceptionally, at the level of elbow and wrist.
What are the symptoms of a stress fracture?
The stress fracture leads to mechanical pain initially linked to the activity (walking, support, sporting movements, etc.) and which cease when it stops. It can exist tenderness to palpation or percussion of the fractured bone. Secondly, pain is present continuouslyeven at rest when the person is not weight-bearing.
How long does it take to heal for a stress fracture?
The rest time varies from one person to another. The bone is considered to be consolidated when there is no longer any pain.. “Overall, depending on the anatomical regions and the physiology of the patient, it is necessary to count between 4 and 8 weeks of time to truly repair the fracture and consider the gradual return to sport“, estimates our interlocutor. In the absence of treatment, the stress fracture can persist for several months.
What are the causes of a stress fracture?
Risk factors for a stress fracture:
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“Unlike a classic fracture, a stress fracture is a lesion which occurs outside of any particular trauma (blow, fall, shock…). She intervenes on healthy bone whose bone density is reduced by different mechanisms and risk factors. To simplify things, healthy bone is an invisible balance on our scale, because it is on the cellular scale, between bone formation and destruction. In certain 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 fragile bone density, particularly in cases of:
- Sudden change in physical activity (overtraining, overuse of the skeleton, too intense return to sport after a long time without doing sport, etc.).
- Low BMI or dehydration.
- After-effects 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 exercise and which persists over time, you should consult his general practitioner who will prescribe the necessary examinations and can refer you to specialists.
What test can diagnose a stress fracture?
“The diagnosis is all the more complex as patients tend to consult pain patients remotely and the context is often not very informative.asks the radiologist straight away. This is why you should always consult a doctor in the event of pain to provide appropriate treatment.“The diagnosis is based on a clinical examinationbut must be confirmed by radiological examination.
► The first-line examination is bone x-ray which can show either signs of fracture or indirect signs of consolidation of the bone (the bone which has repaired itself). When the lesion is too thin, conventional radiography cannot detect it. The x-ray is also used to rule out other pathologies that could be responsible for pain. “There are a certain number of bone lesions that go unnoticed during a conventional x-ray (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 – something the human eye is not capable of seeing – and we will maximize the doctor’s and radiologist’s chances of detecting extremely subtle lesions“, explains the radiologist.
► If the fracture is invisible during the x-ray, we carry out an MRI which makes it possible to clearly detect the bone lesion and theassociated edema (inflammatory reaction).
► In some cases, a bone scan can help highlight bone abnormalitiesbut this is not a first-line examination.
The stress fracture heals on its own. “There are no real treatments apart from complete rest, to give the bone time to repair itself.“, indicates the radiologist. It is therefore necessary to limit movements and avoid putting pressure on the lesion. The use of crutches can help avoid weight bearing for a few days. Neither casting nor surgery is usually recommended. “Limiting activity allows you to turn a corner. However, it must be short to avoid promoting bone demineralization and thus maintaining a vicious circle. This is also a good time to take care of all other potentially added risk factors. In this context, physiotherapy can be beneficial to allow a controlled, adapted and gradual return to physical activity“, he continues.
► Always have physical activity adapted to your physical condition.
► After a long break from sport, resuming physical activity should be done gradually, starting with short sessions and not very intensive.
► Choosing shoes suitable for sportwhich absorb shocks well and with good quality soles, particularly for sports that require support such as jogging.
► Hydrate well before, during and after the session.
Thanks to Dr Alexandre Parpaleix, radiologist, doctor in neuroscience and co-founder of Milvue, a French startup specializing in artificial intelligence in radiology and which has developed specific AI for the analysis of x-rays.