Management for common lower leg stress fractures in athletes

• Published in: Physical therapy reviews 2015-02, Vol.20 (1), p.29-41
• Main Authors: Graham, Elise M., Burns, Joshua, Hiller, Claire E., Nightingale, Elizabeth J., Simic, Milena
• Format: Article
• Language: English
• Subjects: Cumulative trauma disorders; Fractures; Stress; Wounds and injuries
• ISSN: 1083-3196; 1743-288X
• DOI: 10.1179/1743288X14Y.0000000158

Background: Stress fractures are a common overuse injury of bone, comprising up to 10% of all sports injuries, and resulting in pain and loss of game time. They are a consequence of repetitive loading forces on the bone and are often seen in response to an increase in activity or training load. They are especially common in the lower leg in athletes involved in running or jumping sports. Objectives: The objective of this review is to examine the management of stress fractures of the lower leg in athletes. The review discusses pathomechanism and etiology, and management, such as relative rest and activity modification, the use of pneumatic leg bracing, ultrasound, electrical stimulation, laser therapy, foot orthoses, nonsteroidal anti-inflammatory drugs (NSAIDs), less commonly used approaches, and surgery. The review also evaluates the specific management of individual stress fracture sites. Major findings: For stress fractures at low risk of delayed and nonunion, relative rest and activity modification is recommended. The literature regarding other modalities has had mixed results, with studies of low quality or based on military populations. Surgery may be necessary for stress fractures at high risk of delayed or nonunion that do not respond to aggressive nonweight-bearing management. The characteristics of specific stress fracture sites need to be considered throughout rehabilitation. Conclusions: It is difficult to draw conclusions from the literature regarding the many modalities clinically used to manage stress fractures. Further research into these modalities and research into specific stress fracture sites would be useful to guide practice.