For my first patient post allow me to tell you about a patient that came in yesterday:

A 29-year-old female came in with the complaint of swelling and pain in her left ankle.  She states that she had been running for eight days straight and on the eighth day she experienced significant pain and swelling of her ankle during and after her run.  She indicated the area outside of her ankle at and just above her ankle joint.

Physical examination revealed that she had pain with pressure on the outside of her ankle.  There was significant swelling.  There was pain with range of motion.  There was pain at the ankle ligaments that appeared to be an ankle sprain.  However, she reported that she never twisted or injured her ankle.

X-Ray examination revealed what looked like a stress fracture of the fibular bone.  See x-ray below: (click any picture to enlarge.)

Fibular Stress Fracture

This is how I explain what a stress fracture is to my patients, “A stress fracture is not like a regular fracture. To give you an analogy, a regular fracture is like a pencil.  You apply force once and break it in half.  A stress fracture is more like a paper clip.  You apply force over and over again to bend it.  It breaks on the inside before it breaks all the way through. If you continue to apply force to bend it, it eventually it breaks all the way through.”

Stress fractures don't always show up on x-ray like above. Just like the paperclip analogy, you could not tell that the paperclip is broken by looking at it before it breaks all the way through.

Treatment for the stress fracture is immobilization in a fracture brace for four to six weeks. Prior to putting a patient in a fracture brace I often like to confirm the presence of a stress fracture with an MRI if there is any question on the x-ray. I don't like to torture patients by making them wear the brace for four weeks if I'm not sure it is a stress fracture.

The above patient will likely wear her brace for four to six weeks and then slowly increase her activity and run again in six to eight weeks.

Note: in my ten years of practice, I’ve never had a patient come back with a stress fracture in the same bone twice.  They’ve come back with other bones with stress fracture, but never the same bone.

Thanks for Reading, Dr. Sergi