Stress Fractures In Female Runners

● Female runners are 3.5 times more likely than men to develop stress fracture with
approximately 13% of female runners developing stress fracture.

● Common Causes:
        â—‹ Training factors:
                â–  Increase mileage
                â–  Change in training surface: concrete is 10 times more dense than asphalt.
                â–  Starting speed work
        â—‹ Menstrual Disturbances: Hypoestrogenic state accelerates the process of bone
remodeling leading to weakened areas of within the bone.
        â—‹ Osteoporosis/Decreased bone density
        â—‹ Endocrine Factors: Calcium deficiency, Vitamin D dificiency
        â—‹ “Female Triad”: amenorrhea, decrease bone density, eating disorder.
                â–  amenorrhea can lead to average of 4% decrease in bone density/year.
                â–  exercise induced amenorrhea secondary to energy drain on body and
body attempting to conserve energy.
                â–  Oral contraceptive can help offset this hypoestrogenic state.

● Diagnostic Pearls: Pinpoint tenderness, swelling, positive Hop Test.

● Protocol for returning to running after metatarsal stress fracture (must not have pain at
end of each stage to proceed):
        â—‹ Walk every other day 30-40 minutes x 1 week
        â—‹ Running 20 minutes every other day x 1 week
        â—‹ Running 40 minutes every other day x 1 week

● Problematic Stress Fractures:
        â—‹ Navicular Stress Fracture: area of hypovascularity at middle â…“ of bone. If non
displace or incomplete, treat conservatively with 6-8 weeks in NWB cast. 80-
100% go on to union. If displaced or complete, ORIF with bone graft treatment of
choice followed by 6-8 weeks NWB in cast. Return to sport 5-7 months.
        â—‹ Base Second Metatarsal: Almost exclusive to ballet dancers secondary to high
stress placed on 2nd metatarsal during en point position. Treatment consist of 6-
8 weeks immobilization with cessation of ballet/dance activities
during this time.
        â—‹ Medial Malleolus
        â—‹ Sesamoids

● Work up:
        â—‹ Labs: Calcium, Vitamin D, Thyroid
        â—‹ Xrays
        â—‹ MRI/CT scan