Fatigue fracture of the tibia

Definition

A fatigue fracture is most frequently a so-called stress fracture, which occurs particularly in competitive and running sports. They most frequently affect the lower extremity. Initial small cracks eventually develop into a fracture, which is often diagnosed late.

Causes of a fatigue fracture of the tibia

In principle, fatigue fracture is caused by constant excessive stress. In this case, the tibial bone is stressed beyond its capacity over a longer period of time. Small cracks and fissures develop in the bone substance.

The bone is stimulated to decompose and build up the substance, which eventually causes the fracture. Furthermore, one can distinguish between a fatigue fracture in a healthy bone and a pre-damaged bone. If the bone is already unstable, e.g. due to underlying osteoporosis, it is referred to as an insufficiency fracture.

The fragile bone can no longer withstand a load that is already normal and spontaneous fractures occur. If fatigue fractures occur in healthy bones, this is referred to as a stress fracture. They occur especially when sudden changes occur during training.

These include changes in running speed or the surface or even very long running distances. A very large increase in weight can also cause a fatigue fracture. In women, this is particularly favored by a narrow calf with little muscle mass and a thin shin bone.

Symptoms

In contrast to a normal fracture, symptoms of fatigue occur rather slowly. Typically, a stabbing dull pain first occurs during exertion and sporting activity. In resting phases, the pain subsides and then goes away again.

Since many patients do not directly expect a fracture, the symptoms increase until the affected leg can finally be hardly or no longer put under any load. Unlike a normal sudden bone fracture, however, there is no complete loss of bone function. In addition, other symptoms such as swelling can occur in the affected skin section.

Swelling often appears in the area of the foot. If a fatigue fracture develops very slowly on the tibia, one can often feel a tumor-like bulge on the shin through the healing cloud, the so-called callus. If the symptoms occur elsewhere, it may be a fatigue fracture of the heel.

Since a fatigue fracture, unlike an acute trauma, develops insidiously, the symptoms, i.e. the pain, also appear insidiously. The pain is often misinterpreted by those affected as rheumatic complaints. Initially, only slight pain occurs and this only under stress, while at rest it disappears again.

If the leg is not spared now, the pains become stronger and stronger and are not only present at some point under load, but also continue at rest (also at night). This is usually the point in time when the affected person consults a doctor at the latest. In contrast to arthrosis or rheumatic complaints, the pain improves when running.