LEG STRESS-FRACTURE, TIBIA (Fatigue Fracture of the Tibia) |
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General Information
DEFINITION--A hairline fracture of the tibia that develops after repeated stress, such as prolonged standing, marching, running, jogging or walking.
BODY PARTS INVOLVED
Tibia (large bone in the lower leg).
Soft tissue around the fracture site, including muscles, joints, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Pain at the fracture site that lessens or disappears when the load is taken off the legs.
Tenderness to the touch.
Warmth over the site of the fractured tibia.
CAUSESFatigue of the tibia bone caused by repeated overload.
RISK INCREASES WITH
Walking, running, jogging or standing for long periods.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
HOW TO PREVENT
Heed early warnings of an impending fracture, such as leg pain during or after extended standing, walking or running. Reduce activities before a fracture occurs.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis and care.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the lower leg. X-rays are often normal for 10 to 24 days after symptoms begin before bone changes appear.
Radioactive technetium 99 scan (See Glossary), if symptoms are typical but X-rays are negative.
POSSIBLE COMPLICATIONS
Complete fracture with possible dislocation of broken bone fragments if overuse of leg continues after symptoms begin.
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissues.
Problems arising from plaster casts, splints or other immobilizing materials. See Appendix 2 (Care of Casts).
Unstable or arthritic knee or ankle joint following repeated injury.
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex and previous state of health and conditioning. The average healing time for this fracture is 6 to 8 weeks with adequate rest and treatment. Healing is considered complete when there is no pain at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This injury develops gradually.
CONTINUING CARE
This fracture does not require setting (realignment) because the fractured bone is not displaced.
Immobilization is sometimes required. If so, a rigid walking cast is placed around the lower leg.
After cast removal, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, and heat liniments or ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen or ibuprofen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Don't bear weight on the injured leg. Learn to walk with crutches, and prop your leg up whenever possible. See Appendix 3 (Safe Use of Crutches).
Begin reconditioning and rehabilitation after clearance from your doctor.
Resume normal daily activities gradually as symptoms disappear.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a tibia stress-fracture.
Toes become dark, blue, cold or numb while the cast is on.
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