Overview of Stress Fractures of the Lower Leg or Tibia

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A stress fracture of the lower leg in the area of the shin is generally considered an overuse injury. Shin stress fractures can occur due to cumulative trauma to the bones, and the result is a small crack or fracture in the bones of the lower leg, often not visible on radiographs. These stress fractures are sometimes difficult to diagnose and can be misdiagnosed as shin splints.

Shin stress fractures come on slowly over time from cumulative trauma to the muscles and bones, often due to overuse. They occur when muscles become fatigued or overloaded and cannot absorb the stress or shock of repeated impacts. Fatigued lower leg muscles transfer that stress to the nearby bone and the result is a small crack or fracture in the bones of the lower leg.

Causes

Stress fractures are usually caused by overtraining or overuse. Increasing the time, type or intensity of exercise too rapidly is a cause of stress fractures to the feet.  Other contributors may include repeated stress on the bone from pounding or impact on a hard surface, such as running on concrete. High impact sports such as running, gymnastics, and volleyball can increase the risk of stress fractures. In all of these sports, the repetitive stress of the foot strike on a hard surface can cause trauma.  Women seem to be at greater risk of stress fractures than men.

Women seem to be at greater risk of stress fractures than men. This may be related to a condition called "the female athlete triad," which is a combination of poor nutrition, eating disorders, and amenorrhea (infrequent menstrual cycle), that predispose women to early osteoporosis (thinning of the bones). The result of this decreased bone density is an increase in the risk of stress fractures. Without the right shoes, good muscle strength, or adequate rest between workouts an athlete can develop a stress fracture.

Treatment

The best treatment for a stress fracture is rest. Taking a break from the routine and doing some low impact exercise for a few weeks (six to eight) can help the bone heal. If rest isn't taken, lack of healing or even larger stress fractures can develop. Re-injury may result in chronic problems, broken bones and fractures and the stress fracture might never heal properly.

Prevention

The following advice may protect you from developing stress fractures in the first place:

  • Progress slowly in any sport. Gradually increase time, and intensity, running mileage or effort.
  • Eat well, and include calcium-rich foods in your diet, especially if you are a female athlete.
  • If you begin to experience pain or swelling, immediately stop the activity and rest for a few days.
  • If continued pain persists, see your physician.

Any persistent leg pain that continues should be seen by a doctor for a thorough evaluation and diagnosis.

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Article Sources
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  1. Kiel J, Kaiser K. Stress reaction and fractures. Treasure Island, FL: StatPearls Publishing. Updated June 4, 2019.

  2. Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med. 2013;6(2):173-81. doi:10.1007/s12178-013-9167-x

  3. American Academy of Orthopaedic Surgeons. Stress fractures of the foot and ankle.

  4. Cleveland Clinic. Stress fractures: Prevention. Updated June 17, 2015.

Additional Reading
  • Deepak S. Patel, et. al. "Stress Fractures: Diagnosis, Treatment, and Prevention," Am Fam Physician. 2011 Jan 1;83(1):39-46.