Stress Reaction vs Stress Fracture

author : AMSSM

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How does a stress reaction differ from a stress fracture? This article goes into the diagnosis and treatments of both.

Breanne Brown DO
Member AMSSM

Stress fractures are common in runners and occur most often in the foot in the second and third metatarsal. Stress fracture can also occur in other locations but this is the most commonly seen location.

A stress fracture is an actual break in the bone that has occurred usually due to repeated stress to a specific area such as running but can also occur from small trauma as well. An increase in mileage, poor fitness, poor diet, prior stress fracture, and menstrual irregularity in women can all put someone at risk for a stress fracture.

Often a stress fracture is diagnosed with a history from the physician and a physical exam in addition to using an x-ray, bone scan, CT scan or MRI. It can be tricky to diagnose at first and can take up to almost two weeks to see on a x-ray and for this reason if there is a high suspicion often a provider will choose another test to help with the diagnosis. A bone scan is great for seeing injuries to an area in the bone and a special dye is taken up in the area where the injury is located. It can be positive with other disease processes as well so a CT scan can be used to look at bone specifically if the bone scan does not given the appropriate information.  A MRI can look at other structures as well as bone and can see breaks in bone but also looks at soft tissue and can see surrounding swelling.

A stress reaction is commonly seen as well with runners and triathletes. It is a reaction that the soft tissue and bone can demonstrate prior to an actual fracture being seen. It is often diagnosed using the same history and exam from the physician in addition to imaging. It has the same risk factors as well and is often seen on MRI and not x-ray.   The MRI will show edema or swelling in the bone but no actual fracture in addition to inflammation in the surrounding tissue.

In order to treat both of these injuries a person is advised to stop activity and placed in a walking boot and can be made non-weight bearing with crutches depending on the extent of the injury when it involves the foot. Pain control, immobilization, protection of the injured area and a gradual return to activity is how it is treated. Typically a stress fracture or stress reaction in the foot is treated with 4-6 weeks in a walking boot and then gradual return to activity with rehabilitation and modification of activity. Total time for recovery varies from individual based on many factors including compliance to treatment, nutrition, extent of injury and activity level the person is returning to.

A proper diet and calcium in addition to vitamin D is important in order to maintain good bone health and prevent future injuries to the bone from occurring. Also having a coach or knowing the proper way to train with incremental increases in mileage can also help to prevent stress reactions and stress fractures.

Breanne Brown DO
PMG Providence Bridgeport and PMG Sports Care Clinic at Providence Park
Family Medicine and Sports Medicine

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date: October 27, 2014