Stress fractures are some of the most challenging injuries for athletes and active people. Some of them heal fairly easily with rest and other noninvasive options, while others can require much more time or serious interventions. In my latest Ask Dr. Geier column, I answer the question of a reader in Kansas City who asks about the healing of one of the most difficult stress fractures – a tibial stress fracture.

Amelia writes:
In July of this year, I had a lot of pain in my shin and a swollen bump on the inside of my shin. I went to the doctor. I was diagnosed by MRI with a tibial stress fracture in early August. The fracture was about four inches from the bottom of my knee cap. My doctor put me in a boot and on crutches with no weight bearing for 3 weeks. After 3 weeks, I could walk in the boot. Finally after 3 weeks of walking in the boot, I went back to the doctor to see if I could start physical therapy. As she was examining my shin, she pressed on it and the pain was so intense I fainted. She immediately scheduled another MRI, but the results showed healing. She allowed me to go to physical therapy as long as things weren’t too painful. I completed about a month and a half of physical therapy and was finally released to run in early November. I ran for 15 minutes with no pain. The next day, I woke up with my shin as swollen as it was before and pain while sitting, walking, and driving. Stress fractures are supposed to take around 6-8 weeks to heal, so why am I back to square one 3 and a half months later?

There is no doubt, Amelia, that a tibial stress fracture can be a difficult injury for a runner or athlete in any sport. Let me start by saying that not all tibial stress fractures are the same.

Location of a tibial stress fracture and the effect on heal

Tibial stress fractures located on the posteromedial border of the tibia often heal uneventfully. This is the inner border of the tibia (closest to the midline of the body) toward the back of the leg. Often wearing a boot to decrease pain and a period of rest or activity modification can get these injuries to heal in 6 to 8 weeks.

On the other hand, tibial stress fractures in the anterior aspect of the bone can be much trickier. This is the area directly in the front of the shin. Stress fractures in this area of the tibia have a higher rate of delayed union (healing) and nonunion.

Dreaded black line from tibial stress fracture

Treatment of a tibial stress fracture

Orthopedic surgeons are often much more aggressive in treating tibial stress fractures in this location. We might suggest a period where the athlete must keep all weight off of it until it heals (strict nonweightbearing). Occasionally in high-level athletes, some orthopaedic surgeons suggest surgery to treat the stress fracture with a rod placed down the center of the bone or a plate and screws.

Surgery

If the initial treatment does not help the tibial stress fracture heal, orthopedic surgeons often proceed to surgery – either the intramedullary nail or plate and screws. Often the surgeon has to clean out scar tissue at the fracture site and place bone graft taken from another part of the body to help it heal.

Also read:
Ask Dr. Geier: Patellar tendon rupture
Ask Dr. Geier: Return to sports after ACL surgery

Return to sports

Return to sports after suffering a tibial stress fracture in this location can take a long time. Regardless of which treatment method the surgeon and patient choose, the stress fracture must heal completely before repetitive impact is started.

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