Stress fractures and Stress Reactions

We often think of fractures as bones broken in two, something that occurs with acute trauma. If one takes a paper clip and bends it, usually, 4 times, it breaks in two pieces. If took a paper clip and bent it three times and asked you what is wrong with the paper clip, what would you say? It appears to be in one piece but it is not “normal.”  Looking at the paper clip with magnification would demonstrate tiny cracks in the metal.  It is damaged and weakened and if bent again, will break in two. That is essentially what a stress fracture is, a bone that has been stressed repetitively and excessively causing it to form tiny cracks.  Unlike the paper clip, the bone will heal as soon as the excessive stress is relieved. Excessive stress to bones can come from overuse, inadequate shoegear or faulty foot mechanics, poor biomechanics.  Stress fractures often due not show up on x-rays until about 2 weeks after they start to heal. Diagnostic ultrasound is a new and quick way to see metatarsal stress fractures.  We use high resolution diagnostic ultrasound, the Sonosite Edge system.  Diagnostic musculoskeletal ultrasound or sonography is often a good first choice for imaging running injuries.

Now, say that I bend our paper clip twice. Bend it four times, it breaks in two, bend it three times it has tiny cracks but is in one piece. A paper clip bent twice has very tiny cracks.  This is what we may term a stress reaction. The thing to understand is that we are viewing a continuum of excessive repetitive trauma which causes damage to the bone tissue while that same bone isregenerating or healing. If the rate of regeneration is greater than the rate of breakdown all is okay.  Younger people have higher rates of regeneration than middle age and older people. Other factors such as thinning of the bones or osteoporosis/osteopenia comes into play with age, menopause and nutritional factors.




For more information on Stress Fractures in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!