eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Stress Fracture: Follow-up

Author: Jonathan C Reeser, MD, PhD, Office of Research Integrity and Protections, Marshfield Clinic Research Foundation
Contributor Information and Disclosures

Updated: Aug 10, 2009

Follow-up

Further Inpatient Care

  • Most stress fractures are treated successfully in an outpatient setting using conservative measures. Inpatient care is necessary only for individuals who undergo surgical intervention for the treatment of more severe displaced fractures or in an effort to treat a nonhealing fracture. If hospitalized, some patients who have been ordered to restrict weight bearing through the affected limb may benefit from consultation with a physical therapist to ensure safe ambulation. If the patient's symptoms or treatment interfere with his or her ability to independently perform aspects of daily care, a consultation with an occupational therapist may be indicated.

Further Outpatient Care

  • Treatment of stress fractures typically is performed in an outpatient setting. Patients may benefit from physical therapy to maintain overall fitness, thereby minimizing time lost from training and competition once the individual has been cleared to return to their previous activity level. The physical therapist may also assist in identifying intrinsic risk factors that might have contributed to the onset of the stress injury. See Physical Therapy.

Deterrence

  • The optimal treatment for stress fractures is prevention. Ideally, coaches, athletes, trainers, and team physicians should invest themselves in a program of injury prevention that is appropriate to the sport or activity. Features common to such programs include thorough preparticipation physical examinations to screen for risk factors (see Causes); prescription of "prehabilitation" exercises designed to enhance strength, endurance, and coordination; and close monitoring of athletes for early signs that may alert the attentive clinician to an incipient overuse injury.
  • Stress fractures can be largely prevented with proper conditioning and preseason training. Athletes must use proper equipment and wear appropriate shoes to avoid developing stress fractures. For certain foot structures, taping techniques or the use of orthotic inserts can prevent overloading of soft tissues and bone. Nutritional supplementation and increasing calcium intake also contribute to overall bone health and thereby decrease the likelihood of developing stress fractures.
  • The cornerstone of secondary prevention of bony stress injury is a thorough assessment of potentially modifiable intrinsic and extrinsic risk factors unique to the athlete.

Complications

  • Complications of stress fracture may include avascular necrosis, nonunion, malunion, posttraumatic arthrosis, and persistent disabling pain.

Prognosis

  • The prognosis for recovery is dependent on the location and severity of the fracture and on the age and underlying condition and associated comorbidities of the affected athlete. Most stress fracture carry a favorable prognosis for full recovery when appropriate treatment has been provided.

Patient Education

  • Patient education is important in both the prevention and treatment of stress fractures. Athletes need to be educated on proper conditioning programs that decrease their chances of developing stress fractures. For example, the preseason training program should be structured to gradually increase the frequency and intensity of exercise and to avoid sudden increases in training load that might overwhelm the skeleton's intrinsic ability to recover and repair.
  • Once diagnosed with a stress fracture, the affected individual must be made to understand the importance of a period of relative rest/activity modification. Athletes should review their training history for evidence of significant training errors or overload and adjust the training program accordingly. Educating the patient in an outpatient program of progressive muscle strengthening and conditioning will enable the athlete to return safely to his or her sport once their bony stress injury has healed.
  • For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center and Sports Injury Center. Also, see eMedicine's patient education article Repetitive Motion Injuries.

Miscellaneous

Medicolegal Pitfalls

  • Failure to complete a thorough history and physical examination of an individual with a stress fracture may result in an inaccurate diagnosis, which in turn could result in inadequate or inappropriate therapeutic intervention.

Special Concerns

  • Early diagnosis and treatment of compression fractures of the femoral neck are important. Complications of undetected displaced fractures of the femoral neck may result in avascular necrosis and nonunion.
 


More on Stress Fracture

Overview: Stress Fracture
Differential Diagnoses & Workup: Stress Fracture
Treatment & Medication: Stress Fracture
Follow-up: Stress Fracture
Multimedia: Stress Fracture
References
Further Reading
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Keywords

stress fracture, stress fractures, metatarsal fracture, stress fracture foot, stress fracture treatment, stress fracture symptoms, stress fracture tibia, tibial stress fracture, stress fracture femur, fatigue fracture, insufficiency fracture, stress fracture of the lower limbs, lower limb stress fracture, overuse injury, overuse injuries, bone mineral density, disrupted bone homeostasis, inadequate bone repair, bone strain, pars interarticularis stress fracture, spondylolysis, neck of the femur stress fracture, femur neck stress fracture, stress fracture of the tibia, second metatarsal stress fracture

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Contributor Information and Disclosures

Author

Jonathan C Reeser, MD, PhD, Office of Research Integrity and Protections, Marshfield Clinic Research Foundation
Jonathan C Reeser, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, Phi Beta Kappa, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and State Medical Society of Wisconsin
Disclosure: Nothing to disclose.

Medical Editor

Everett C Hills, MD, MS, Medical Director, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Assistant Professor of Neurology, Penn State Milton S. Hershey Medical Center and Penn State University College of Medicine
Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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