Tibial Stress Fractures

A tibial stress fracture is a fortunately uncommon cause of leg pain in athletes, especially running athletes or those who participate in repetitive landing from a jump, such as gymnastics. Typically athletes complain of pain that increases over a period of time, usually in response to increased stress. A common story is a runner who is increasing his or her training over a short period of time. Often he or she starts having pain that comes on with a run, and over the next few days or weeks, the pain comes on sooner and takes longer to go away after stopping the run. After a while, pain persists with activities of daily living, such as walking.

Tibial stress fracture
Note the increased uptake in the mid-tibia on the bone scan of this young athlete.

In the office, the physician will perform a history and physical examination. Examination of a tibial stress fracture will often reveal a more localized pain than shin splints, although this finding is not always true. Usually tightness of the calf muscles and numbness and tingling are absent. X-rays will often show a tibial stress fracture if symptoms have been present long enough. Physicians often refer to the x-ray findings as “the dreaded black line,” which is a break in the cortex of the bone but no fracture all the way through the bone or any displacement of the fracture. If the symptoms are fairly recent, x-rays might not show a stress fracture, so further testing, such as bone scans or MRI’s, are often used. Tibial Stress Fractures and Athletes.

Treatment of a tibial stress fracture can be either surgical or nonsurgical. This is potentially a worrisome diagnosis, as continued stress on a tibial stress fracture could lead to a complete fracture and require surgical treatment. If nonsurgical treatment is elected, many physicians recommend complete nonweightbearing and use of a cast or walking boot. At a minimum, absolute refrain from the offending activities and sports is mandatory. If the fracture is not healing, we often consider surgical treatment. Tibial stress fractures, especially in the setting of delayed healing, involves placement of a nail down the center of the bone with or without additional bone grafting to try to stimulate healing of the bone.

The Dr. David Geier ShowSurgery for a tibial stress fracture?

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Recovery from a tibial stress fracture is lengthy whether or not surgery is performed. Usually physicians will not let the patient return to sports or exercise such as running until the fracture has completely healed. That process can often take three to four months. At that point, activities are gradually introduced. The time to return to sports is lengthy, but if the fracture heals uneventfully, return to full participation with no limitations is often seen.

If you have specific questions about tibial stress fractures, please Ask Dr. Geier directly.

15 Responses to Tibial Stress Fractures

  1. hie, I met an road accident about an 4months ago.i broke my right tibia..compound fracture doctor planted a metal rod and two nail inside my leg…now I m walking without crutches. .can I play badminton after a few months..

    • Patients can usually return to sports and exercise after surgery for a tibia fracture when the bone has completely healed and the patient has regained full motion, strength and ability.

  2. I’ve been diagnosed with bilateral tibial stress fracture. My left leg is the one that hurts. My ortho doctor didn’t put me in a boot or cast. Just said no running. Is this protocol?

    • The treatment necessary for a tibial stress fracture can vary depending on the specific location of the fracture. Some stress fractures need periods of complete nonweightbearing, while others can potentially be treated by just limiting repetitive impact.

      • They don’t hurt anymore. When I’m resting, my shins feel like I rubbed icee cool or have a heat pad on them. Is this normal?

  3. I have had medial tibial stress syndrome for almost 3 years now, and the last time I was cleared for a stress fracture/reaction was last year. At first my left shin would only hurt when I was jumping or running. Now, it still hurts running and jumping but also after activity, the spot on my shin aches and it barely hurts to walk. I am going to get an MRI tomorrow, but how likely is it that I have a stress fracture?

    • I really can’t say or predict without being involved in your care. If a patient’s pain is increasing, coming on earlier or taking longer to go away, or is more pinpoint in location, then a stress fracture could be more likely.

  4. I have a tibial stress fracture from running and was told to use crutches for three weeks. In general, is this really necessary once the pain has subsided (as it has, in my case). Feels silly to use crutches when nothing hurts.

  5. Hi, i have a tibia plateau fracture that’ shattered my knee a little over a week ago. I had surgery and had a bunch of screws put in. I am now in recovery and just lay all day with my leg elevated besides when I have to use the restroom. Only concern is when I do go use the restroom or if I flex my foot my calf muscle is extremely sore. Should I be worried or isn’t just post op pain? It’s also painful to massage the calf even when not flexed, but when laying down there is no pain.

    • Laura, I can’t really give you specific information or advice, but you should run your concerns by your orthopaedic surgeon. It is possible for a patient to develop a blood clot in her leg after surgery, but she can also have pain related to the fracture and surgery.

  6. I have been experiencing pain for 5 weeks in tibia region and have ceased running during that time. I had been running through discomfort for 2 weeks prior to that. Over the resting time I felt as if the pain was getting better (still do feel it though, even just when walking) and I put off seeing a doctor until mid week 4 and had an MRI done at the 5 week mark, which showed a grade 1 stress injury. I am wondering, if I had the MRI done 3 weeks ago, when the pain was at its worst, is it possible the MRI would have shown a more severe injury and that the injury had healed down over the weeks?

    • I can’t say in your case, but if a patient has a stress fracture, an MRI later in the process could show less edema and a resolution of the fracture line.

  7. i m having pain both legs which is localised in my tibial bone .it increasd in prolonged standing walking and i can not jump.pain is pinpointing.whn touched at that point pain is unbearable.i m not athlete but why i got stress fracture and wht to do in my case.
    x ray n ct scan shows line on lower third of tibia

    • I can’t say without seeing it, but if a patient has a tibial stress fracture, then I would recommend seeing an orthopedic surgeon and following his or her advice for treatment.

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