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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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There are a variety of other diagnoses that the health care practitioner may consider when making the diagnosis of a stress fracture.

Some conditions that may mimic a stress fracture include:

• Sprains: Sprains are damage to a ligament that stabilizes a joint.
  
  
• Strains: Strains are damage to a muscle or tendon.
  
  
• Referred pain from the back: Examples of referred pain from the back include sciatica or arthritis in the low back that causes pain felt in other areas of the body (leg pain from sciatica for example).
  
  
• Shin splints: Shin splints are referred to as medial tibial stress syndrome (or medial tibial traction periostitis) and cause anterior shin pain due to swelling in the lining of the tibia or shin bone.
  
  
• Plantar fasciitis: Plantar fasciitis is an inflammation of the ligament in the arch of the foot.
  
  
• Morton's neuroma: Morton's neuroma is a benign growth that affects the nerve between the third and fourth toes of the foot.

The health care practitioner will gather the appropriate information to help make the correct diagnosis.

The initial injury may be difficult to remember, but the health care practitioner may ask questions about how long the pain has been present, what makes it better or worse, and whether the pain has progressed or changed.

Past history will be helpful to access underlying risk factors for a stress fracture, including medication use and nutrition history. The diagnosis of an eating disorder and resultant osteoporosis may be considered in younger women with stress fractures who have stopped menstruating.

Physical examination may reveal a specific tender area that reproduces the pain, but the physical examination can only raise the suspicion of a stress fracture. The health care practitioner may check muscle strength, flexibility, and bone alignment as possible risk factors for stress fracture.

Plain X-rays do not show a stress fracture. However, if they are taken weeks after the symptoms begin, there may be evidence of extra bone that is being formed at the fracture site as the body heals the area.

Magnetic resonance imaging (MRI), computerized tomography (CT), and bone scans may be ordered to identify a stress fracture. CT and MRI scans look directly at the bone, but a CT scan requires the use of radiation, and an MRI scan is not often readily available. A bone scan uses a radioactive tracer injected into a vein in the arm to demonstrate areas where bone cells have increased activity and blood supply.

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