Imaging is adjunctive to patient history and physical examination ( Table 3). Additional physical examinations are typically unremarkableĪbbreviation: MRI, magnetic resonance imaging.S I and/or buttock pain during palpation and load bearing activity.Strain deep external rotators or piriformis. Point tender (may be extreme) on pubic rami.Pain with single leg stance on affected side.Internal fixation recommended in stress fractures on the superior neck Surgical when conservative treatment fails – intramedullary rodding Focal pain during weight-bearing/or activity along tibial shaft.Malignant tumor (medial tibial condyle).Ligamentous injury (medial malleoli, tibial condyle).Meniscal pathology (medial tibial condyle).Surgical management suggested if conservative treatment unsuccessfulĬonservative management 1st through 4th metatarsal Pain during weight bearing and push off.We present evidence-based concepts regarding lower extremity stress fractures to provide practitioners with an updated overview of diagnosis, treatment, and rehabilitation. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Regardless, early recognition is the optimal goal to minimize the potential for microfractures to become macrofractures. 12Īccurate diagnosis for stress fractures is dependent on the anatomical area. 1, 2, 7, 13– 15, 17– 19 Stress fractures occur due to overuse and/or overload, when the rate of stress-induced microfractures exceeds the rate at which bone repairs, requiring the recognition and management of risk factors. 3 The most common stress fractures occur in the tibia (23.6%) but also develop in the tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%). 3, 6, 9, 16 Specifically, stress fracture incidence in runners approaches 16% of all injuries. 1– 20 Stress fractures in the lower extremity account for 80%–90% of all stress fractures, representing between 0.7% and 20% of all sports medicine injuries. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management.
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