Member Case Study: Recurring Stress Fractures

author : AMSSM

comments : 0

Earlier this year I had 2 stress fractures on my left foot. Both requiring 6 weeks rest. I am finally running injury free. How likely am I to get a stress fracture in the same location?

Member Question from riorio

Earlier this year I had 2 stress fractures on my left foot. Both requiring 6 weeks rest. I am finally running injury free. How likely am I to get a stress fracture in the same location? Does having a previous stress fracture mean I am more likely to have it happen again?

I am taking all the precautions I can think of - I had my running form evaluated, purchased new shoes as recommended by a running shoe store and I no longer run on consecutive days. The thought of getting another stress fracture is always on my mind, especially as I up my mileage to train for an OLY and half-marathon.

Answer from Margarita Sevilla, MD FAAFP
Member AMSSM

Stress fractures are indeed very frustrating for athletes. The fact that you had two stress fractures in the same foot in a short span points to a biomechanical issue with your running or to excessive training. Sometimes doing too much too fast contributes to having more stress on those bones with not enough time to adjust.

Stress fractures are usually classified as high risk or low risk, and based upon the treatment that you received from your physician it sounds like they were low risk stress fractures. This classification refers to how quickly the fractures heal, and typically depends on the location of the bone and its blood supply. There is not necessarily more risk of having a recurrent fracture in the same place unless you don’t allow enough time for healing and return to training before the bone is completely healed. By running on alternate days, and looking thoroughly at shoes and running technique, it sounds like you are doing many of the right things.

You should also have a sports medicine physician or a foot and ankle doctor look at your feet. Certain biomechanical characteristics have been shown to be related to recurrent fractures, including a narrow tibia, a high degree of external rotation of the hip, a high longitudinal arch of the foot and a leg-leg discrepancy. Cross training is a great way to take the load off running, and is ideal for your triathlon training. You can add water running and some elliptical work on your running days. It is also good to vary the surfaces where you run.

My last suggestion, since you did have two stress fractures, would be to talk to your doctor about bone density studies. A bone density study would check to make sure that your bone density is normal. Key things to help assure good bone density are adequate nutrition, including calcium, and regular menstrual cycles. Factors that may slow healing of a stress fracture are smoking and use of anti-inflammatory medications. Good luck with your training.

Margarita Sevilla, MD FAAFP
HCMC Sports Medicine
Minneapolis, MN

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date: September 13, 2007