Diagnosis
Usually, a fatigue fracture is diagnosed very late. Many athletes do not take the initial pain in the shinbone too seriously and hope for improvement when they take a break from sport. However, as the symptoms get worse, most of those affected do not go to the doctor until there has been no improvement and a significant reduction in performance has already occurred.
The doctor will first take a medical history, focusing mainly on the occurrence and duration of the symptoms. This will give a first indication of an underlying disease. The doctor will then palpate the affected leg as part of the clinical examination.
In most cases, the non-painful leg is also examined in order to compare the two sides and to detect changes in the diseased leg more easily. The patient may also report pressure pain in the diseased leg. The doctor is not able to feel the fine cracks and fissures.
In order to diagnose a bone fracture with certainty, imaging procedures must be performed. In addition to conventional x-rays, computer tomography, magnetic resonance imaging and skeletal scintigraphy are also possible.The last two methods in particular are being used more and more frequently in diagnoses because they provide particularly high image quality and can also very well depict soft tissue structures. Thus, diseases of the surrounding muscle and tendon structures can be excluded. Pain-causing bone tumors such as osteosarcoma can also be excluded by means of the precise examination procedures. Once the diagnosis is confirmed, the doctor can initiate appropriate therapy.
Therapy
Fatigue fractures are usually treated conservatively. If a fracture is present in its early stages without complications, it is usually sufficient to take a longer break from training, especially jogging. The tibia then has enough time to regenerate and fill the fine cracks and fissures with new bone substance.
Depending on the physical situation and also the age of the patient, this healing process takes six to eight weeks or, in the case of more severe fatigue fractures, even up to half a year. The affected leg should be well protected and therefore not be fully loaded. Plaster casts are often used for more severe or advanced fatigue fractures.
They immobilize the leg and ensure that the leg is not loaded after all. Analgesic and anti-inflammatory medication can be taken at the same time. In extreme cases, it may also be necessary for the fracture to be treated surgically.
The fracture may then be treated with screws and metal plates. The advantage of an operation is the faster loading capacity afterwards. This can be the case, for example, if the crack in the bone has progressed very far into the depths.
Once healing is complete, the load can be resumed. For athletes, it is important to start training slowly and gradually increase the load so that the leg can get used to the sport again and adapt. A cast is usually required when a stress fracture has occurred, i.e. when it is not a preliminary stage of fatigue fracture.
The cast or splint is used to relieve the fractured bone. In most cases, the plaster is a so-called walking plaster, which may be used to make an appearance. The plaster should normally be worn for a period of two to six weeks to relieve the fatigue fracture.
Afterwards, the load can be gradually increased and the treatment can be supported by physiotherapy. If the shin is spared, a fatigue fracture usually heals without consequences. The duration of the therapy usually extends to six to eight weeks, after which a cautious attempt can be made to resume sports activities.
However, it may take up to six months before the leg can be fully exercised again. Even though the process can be slow, you should not start with a load earlier out of impatience. If pain reoccurs, the load should be reduced again, as otherwise bone inflammation, a precursor of a fatigue fracture, may occur again.
If a diagnosed fatigue fracture of the tibia or an imminent fatigue fracture is detected, sport should be avoided in any case and other unnecessary stress should also be avoided. Especially in the early stages or a preliminary stage of the fatigue fracture, this protection is often sufficient as therapy. In the time of the sport break the bone has now the possibility to regenerate by its own power. As a rule, sports should be avoided for six to eight weeks. The duration of this period usually varies from person to person and depends on the patient’s pain as well as the healing signs in the X-ray image.
