Lower leg comprises of 2 bones, tibia and fibula. Tibia is also known as the shin bone. The main function of tibia is weight-bearing. There are many muscles which are attached to the tibia and when these muscles contract, they apply a pulling force on the bone. When there is too much weight bearing and excessive pressure to the tibia, it causes compressive force through the tibia resulting in damage to the bone. If the damage continues or the force applied to the bone continues then it leads to a tibial stress fracture. Tibial fractures are more common than fibula fractures, as tibia is the main weight-bearing bone. It is also larger than fibula and thus is more susceptible to stress fractures, especially in the lower third region.
Symptoms of Tibial Stress Fracture
- Pain is present in the outer region of lower third of the tibia.
- Acute pain that increases with activity and decreases with rest.
- The site of the fracture will have swelling.
- Walking may be difficult and produce pain.
- Pain may even be present at night or at rest.
- Pain upon pressure to the shin.
Causes of Tibial Stress Fracture
- Excessive weight-bearing on the bone due to continuous muscle contractions as seen in running.
- Prolonged running causes fatigue in the muscles, which distributes the stress to the bone and leads to fracture.
- A change in training regime such as running on uneven surfaces after running on even surfaces such as grass or road.
- Repetitive stress or impact to the bone ultimately results in a fracture.
- Other contributing factors for a tibial fracture are: Excessive training, bad foot posture, poor biomechanics, weakness or fatigue or stiffness in the muscles, joint stiffness, ill-fitting footwear, leg length inequalities, obesity and menstrual irregularities.
Diagnosis for Tibial Stress Fracture
A complete subjective and objective examination by a physician confirms the diagnosis. X-ray MRI, CT scan or bone scan helps in further confirmation of the diagnosis.
Treatment for Tibial Stress Fracture
- Rest should be taken for at least eight weeks.
- The cause of the fracture should be analyzed and if it is due to change in training then that activity should be avoided in the future.
- Crutches can be used to avoid complete weight-bearing.
- Orthotics can be prescribed by the physician.
- Soft tissue massage is beneficial.
- Electrotherapy such as ultrasound can be done.
- Appropriate footwear should be used.
- NSAIDs or other pain killers can be given to alleviate the pain.
- Exercises for the lower leg should be started to maintain strength, flexibility and balance.
- Gradual return to training and sports.