Symptoms & Treatments

Stress Fracture

Pain in the legs is commonly seen in running athletes. Often, upper leg pain occurs with the start of a new training session or after changes in a normal training routine. An athlete who is used to running three to five miles a day may develop pain in the upper leg after increasing the distance to ten miles on a regular basis.

While there are several causes of generalized pain, one of the more difficult ones to manage is the result of a stress fracture of the tibia. This is usually localized to the upper portion of the tibia below the knee joint. Pain is exacerbated by running and usually is of such severity that the athlete is no longer able to continue with running or other impact aerobic sports. This is also occasionally seen in new military recruits who are not used to a formal daily training routine. It can also be seen in individuals involved in an aggressive, high-impact dance aerobics class.

The repetitive stressing of the bone results in microfractures that are responsible for the pain. The most common location is in the upper leg bone, but occasionally similar problems are encountered across the metatarsal bones of the forefoot or in the heel bone of the hindfoot. In nearly all cases, a sudden change in activities is responsible for the problem.

Treatment depends upon an accurate diagnosis. Patients should also be evaluated for other conditions such as tendinitis or shin splints that may be responsible for a similar type of pain. Routine X-rays are often negative in the early stages of these conditions. A specialized test, known as a bone scan, measures blood flow to the injured area. Often a bright line will appear on the scan-localizing the stress fracture. Treatment is basically conservative, with avoidance of running activities. Diehard fitness enthusiasts usually can substitute a different exercise, such as swimming or bicycling to maintain aerobic fitness. All forms of impact aerobics need to be eliminated until healing occurs.

Resolution of symptoms may take several months. Unfortunately, calcium supplements, shoe wear, and braces do not seem to make any difference. Avoidance of certain activities allows symptoms to resolve in time.