Neil:
Can you take the "stress" of another question about stress fractures?? I am a
39 year oldlow level runner that had managed to work up to about 17-20 miles a
week. About four weeks ago i developed pain in the top of my foot and on the
ankle. After a week of RICE, i decided to go to the ortho who told me I had a
stress fracture of the distal tibia. He put me in a walking boot brace and told
me to ride s stationary bike for three weeks. I went back today for my three
week look and he tells me the xray today show a "line" on the ankle bone which
he thinks is the fracture. Three more weeks in the boot!! He did also say that
we could do a bone scan to make sure that was the source of the problem. Two
questions: 1. Does this course sound reasonable to you? Why didn't the "line"
show up on the first xray? 2. Is there anything I can do to maintain
endurance? I have been riding the bike for 30 minutes three times a week (very
boring!!).
Tim:
If you indeed have a fracture of the distal tibia, it wouldn't be a total suprise since ther is scan't blood supply in the distal tibia, and it is a sight of frequent stress fractures. As far as the reason for the fracture not showing up early in the first x-ray is concerned, simple explanation: An x-ray can only "see" a 50% change in bone density, and a stress fracture might not be close to that. On the other hand, a bone scan shows a 2% change in bone density, and as a result is the more sensitive tool in picking up simple fractures. Your fracture might not have been remodeled at teh time of the first x-ray. As far as a course of investigation and treatment is concerned, this path is exactly right on. As far as additional activities are concerned, try hitting a light punching bag to keep your endurance up. I suggest a 40# water core bag (we use a bag called "the wave" in our clinic). Good luck
