Multiple Lower Extremity Stress Fractures

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Question:

How common is it to get more than one stress fracture on one bone? For example, having a stress fracture mid calf on tibia and then getting one lower tibia near ankle and medial malleolus.

Answer:

Stress fractures in the lower extremities (i.e. pelvis, thigh, legs and feet) are common in athletes who participate in repetitive high impact activities such as running and jumping. Studies have found stress fracture rates as high as 20% in competitive track and field athletes and 13% in elite tennis players. 
There isn’t as much data available regarding how common recurrent stress fractures are in the same bone, however most sports medicine physicians consider a history of more than one stress fracture concerning and a reason for further workup. This first involves identifying any training errors such as increasing activity intensity too quickly, improper shoe wear, or abnormal running mechanics.

Treatment Options:

A nutritional evaluation by a sports nutritionist may also be recommended. Oftentimes athletes think they are eating a healthy diet, but may not be taking in enough calories for the amount of exercise they are participating in. In female athletes this often leads to changes in hormone levels and irregularities in the menstrual cycle that can negatively affect bone health. 

Your physician may also consider ordering a DEXA scan to evaluate your overall bone density, blood work including vitamin D levels, and urine tests to look for an abnormal loss of calcium in the urine that runs in some families. These tests are relatively easy to perform and can often help identify treatable risk factors for stress fractures. 

If you have been diagnosed with more than one stress fracture it is important to meet with a sports medicine physician to help identify and treat any risk factors that can prevent future injury.

- Dr. Leda Ghannad