Rigid Cavus foot will predispose to stress fractures due to poor shock absorption.
Excessively pronated foot may lead to excess muscular fatique and poor impact absorption.
Gradual onset of shin pain aggravated by exercise.
Pain may also occur at night.
Stress fractures of the posterior cortex may produce symptoms of calf pain.
Localized tenderness over the tibia. Usually on the medial border.
Bone Scan or MRI are the preferred investigations.
Plain films in the subacute time may reveal the 'dreaded black line' of a non-union of the midshaft anterior cortex.
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In the acute phase, most injuries will benefit from the R.I.C.E regime
Initial period of rest is needed until pain subsides. This may require a period of non-wt-bearing.
Rest is continued until bony tenderness disappears (4 to 8 weeks).
Once the patient can wt bear without pain and bony tenderness has disappeared, a gradul reintroduction to exercises ensues. Alternative exercises such as cycling and swimming should be prescribed during the layoff.
Transverse friction over the painful site may halp to reduce soft-tissue thickening.
Identification of cause of fracture is needed. These factors must be corrected (excessive training, hypoestrogenemia, dietary)
The use of the pneumatic brace (Air-Strirup Leg Brace) has been proven to reduce time to return to sport (avg of 21 days rather than 77 days). The brace can be used upon return to activity.
Note that stress fractures of the anterior cortex of the mid-shaft of the tibia are especially prone to non-union a progression to complete fracture. This area is particularly vulnerable to non-union due to poor blood supply and severe tension due to morphological bowing of the tibia. In this case, the athlete should not return to activity until there is radiographic evidence of healing.
For non-healing anterior stress fractures of the mid-shaft of the tibia, surgical repair may be required after a failure of conservative treatment for 4 to 6 months. This may involve drilling at the fracture site, intermedullary rod, or bone grafting.
Many injuries can be prevented by following some general rules for injury prevention