Stress Fractures

Question 1

Name some intrinsic factors that relate to etiology of stress fx.

Answer 1

1. foot type
2. prolonged NWB
3. bone mineral density
4. estrogen/hormone levels

Question 2

Name some extrinsic factors related to etiology of stress fx.

Answer 2

1. overuse- distance running**
2. changes in training regimen: frequency, duration, intensity
3. error in training or technique
4. change of surface
5. shoe gear
6. usually NO trauma noted
7. diet
8. medications

Question 3

What is the female athlete triad?

Answer 3

1. eating disorders
2. irregular menstrual cycle
3. osteoporosis

Question 4

What is the Torg classification for 5th metatarsal stress fx?

Answer 4

Type 1- Acute: no previous fx; acute fx line with sharp edges, usually only thru lateral cortex
Type 2: fracture line involves both cortices; periosteal new bone and intramedullary sclerosis
Type 3- Chronic: wide fx line; obliteration of medullary canal by sclerotic bone at fx site

Question 5

Which part of the navicular is most commonly fractured?

Answer 5

central 1/3 is most common area due to it being the watershed area as well as shear forces from 1st and 2nd met and pressure from talus

Question 6

how long should NWB treatment be for stress fx of navicular?

Answer 6

NWB 6 weeks

Question 7

S/S of stress fx

Answer 7

• slight swelling
• no bruising
• pain on dorsum of foot
• pain that develops gradually and increases with WB activity and decreases with rest

Question 8

other DDx?

Answer 8

morton's neuroma
capsulitis/ predislocation syndrome
tendonitis
bursitis
plantar fasciitis

Question 9

Where do fragility fractures mostly occur?

Answer 9

metaphyseal areas

*ankle especially

Question 10

treatment of stress fractures?

Answer 10

rest and cessation of inciting acitivy

*use rigid soled shoe, CAM walker, cast, crutches