Foot and ankle joint

Fatigue fracture

Złamanie zmęczenioweThis injury, also called a stress fracture, can be located in many places of the osteoarticular system. It most frequently applies to tibia, metatarsal bone, heel bone and fibula. Runners and triathlonists are more exposed to fatigue fractures, this group also involves other athletes, tennis players and team players, such as footballers, basketball players and volleyball players. This injury is  a way more frequently contracted by amateurs, especially highly ambitious ones. It rarely bothers professionals or persons who have a comprehensive knowledge of the training and organism functions. The fatigue fracture may suggest that your training in unsuitable; if you fail to modify it, recurring injuries may cause you to resign from your favorite sports.

Fatigue fracture – causes

As opposed to regular bone fractures, a fatigue fracture does not arise from a sudden injury. It develops gradually, even for a few weeks. The cause is minor but frequent bone micro-injuries accompanied by excessive ligament overload and muscle fatigue, which in turn results from a long-term and strenuous workout. The fatigue fractures are mostly sustained by runners whose training is wrong. Typical mistakes are the following: too frequent workout, too long effort and extensive load. This is because you don’t pay enough attention to rest and regeneration of bones, joints and ligaments after workout. The factors which boost fatigue fractures are badly-chosen footwear which fails to absorb vibrations, running on hard surface, doing several sports which overload your bones and joints at the same time (e.g. running and tennis). On the other hand bone and joint overloading may arise from hard workout and high body weight – obesity.

Runners’ fatigue fracture

  • Excessive workout load
  • Exercises done in a wrong way,
  • No warm-up before the workout,
  • Too short regeneration between workouts,
  • Defects affecting the body biomechanics,
  • Badly-chosen footwear,
  • Combining hard workouts (e.g. running and tennis),
  • Obesity, bad diet.

Fatigue fracture – symptoms

Initially the pain is mild and manifests itself after a workout only. It is not irritating so we do not pay attention to it and we keep on working according to our training plan. However, a few weeks later pain intensifies, gets more frequent, also during workout.

With time the pain is more irritating, even when we take everyday activities. It can be deep, sharp, radiating to the external side of the limb. Bones often have noticeable swelling, edema and reddening which suggest the fracture spot.

Fatigue fracture – diagnostics

With regard to fatigue fracture, the priority of the specialist is to take a medical history and perform a clinical test. Another step is to perform X-ray scanning and ultrasound examination. If the fracture is at its early stage, it can be invisible and X-ray scan is unable to show changes. In serious cases (e.g. pelvis, backbone), it is necessary to focus on further diagnostics and perform further tests, such as magnetic resonance and scintigraphy.

Najczęściej spotykane lokalizacje złamań zmęczeniowych:

  • shinbone – ca. 30%
  • tarsal bone (navicular bone) – ca. 20%
  • metatarsal bone – ca. 20%
  • thighbone – ca. 15%
  • fibula – ca. 10%
  • pelvis – ca. 5%

Fatigue fracture – treatment

According to PhD Andrzej Warzocha, a Rehasport Clinic orthopedist from Gdańsk, the fatigue fracture treatment is dependent primarily upon the location and cause of the injury. A specific approach refers to a workout overload, and a completely different strategy is adopted with respect to susceptibility to fatigue fracture arising from anatomy, e.g. shinbone or hormonal imbalance leading to osteoporosis. The basis is a non-surgical treatment focused on eliminating the cause, that is reducing the workout intensity, using surgical footbeds, brace, elbow crutches, as well as balance hormonal disturbance.

Surgical treatment is advisable in the case of specific types of fractures – some thighbone neck fractures, fatigue fracture of metatarsal V bone or when non-surgical treatment proves to be ineffective.

Fatigue fracture – be back to sport

Many sportspersons perceive a fatigue fracture as one of the worst things ever. They are afraid of recurring fractures, which may have a considerable impact on their further sport career. The truth is however that it is rehabilitation that determines the risk and therefore a proper recovery. The recurring fracture risk, as PhD Andrzej Warzocha from Rehasport Clinic in Gdańsk says, is minor if the causes of the original fracture are eliminated. It is possible to retake regular sport activities usually after about 3 months when the radiological examination confirms that the fracture has healed properly. If this is the case, a check-up examination is just like at the beginning – X-ray scans and magnetic resonance imaging.

Fatigue fracture – how to prevent?

  • Do not increase workout loads and prolong workout too rapidly.
  • Make sure to have necessary breaks between trainings, devote them to regenerate.
  • Enrich your running training with general and stabilization exercises.