fibular stress fractures

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Any thoughts relating to fibular stress fractures?

Literature suggests peroneal activity at toe off is implicated. The fibular does not play such an important role in weight-bearing so torsional movement must be a causal factor..

Thanks for some thoughts

 

Hi L Fibular does take quite a bit of load -

Heres some reading for you.

http://www.ejbjs.org/cgi/reprint/53/3/507

 

Hi Mark,

Thanks for that reference. I needed to put some extra thought into this topic and thanks alsoto LMadeley for raising the topic of fibular stress.

I'm treating two case at present with persistent pain located at about the distal 1/3 point of the fibular.

In both cases the pain has been sharp and in the general area including soft tissue.
Releasing triggers in peroneus tertius which attaches there has removed the bulk of the pain but it has persisted on the bone at medial side of the fibular in a very discrete area.
At this stage mechanical interventions have had less impact but I think still helping.

One case is with a sprinter and the other is a snow boarding injury that had not responded to any treatment for two years. The sprinter hasd a previous history of navicular stress fractures and I suspect overcorrected with orthoses.

So we have torsion, overloading and I'd suggest also perhaps excess traction from PT in this location as stress factors.

I think (and am very open to other suggestions) that I need to revisit the mechanical issues as it seems that changing the angle of the talo-fib jt at all stages of gait may reduce the stress.

So thinking out loud and await next appointments to work out what actions to take.

Thanks again

Shane

 

As a student I read a book on Kinesiology by Steindler. In Steindler's book he talks about eccentric vs. concentric loading of bones. 25 years ago, I applied this principle when I looked at stress fractures. Weakness of the peroneus brevis was what I found was the cause of fibular stress fractures. I used assist tapings for individual muscles that I wanted to test and had the patient jump with it. The taping that prevented pain was the one that provided concentric loading. The taping that substituted for the peroneus brevis was the one that eliminated pain on jumping. I would then have the patient walk 3 miles per day with the tape for 2 weeks then run for two weeks with the tape and then if able to, run without the tape.

Regards,
Stanley

 

Thanks Stanley,

Your experience is always appreciated.
I actually did use some taping as well which did seem to provide assistance.
I have the snowboarder (who still has a niggle), away for snowboarding in Japan for two weeks and using an ankle wrap to provide that bit extra beyond her devices.
I will check the PB when she gets back and always still wonder why there is a weakness in the first place - more as a result of something else rather than a primary condition?
Cheers
Shane

 

Hi Shane,

It can be a primary condition or a result of something else.

In my opinion, there are lots of reasons why the peroneal muscles can be weak. The most obvious reason is lack of exercise, but this is rarely the case.
Years ago, I gave a lecture once at a road running club and I talked about how weak posterior tibial muscles contribute to shin splints. At the end of the talk a runner came up to me and asked me “Why are my muscles weak, I have been running for 20 years?” He made an excellent point. The muscles shouldn’t be, so we can look at dysfunctions as a cause.
We can start with the muscles themselves. A simple contraction injury or stretch injury (strain counterstrain or reverse counterstrain) can cause a weakness after contraction or stretching.
Another thing that can cause weak peroneals is any dysfunction along the lateral line of fascia (check out anatomy trains). These dysfunctions can include a subluxed cuboid, fibular, or fixation of C7 and the first rib.
Any problem in the acupuncture system, including emotional problems can cause peroneal weakness as well as cranial sacral dysfunction.
Then there are a host of less common causes.

Regards,
Stanley

 

Dear Stanley
good to see your thoughts.I agree entirely.

I only disagree with the word 'weak'.
They are not weak, they are inhibited and thus act weekly.
Regards
Paul Conneely

 

Paul,

I agree. The choice of weak had to do with the context. I was responding to "always still wonder why there is a weakness in the first place". I should have changed the terminology when I answered.
Thanks for clarifying. :drinks

Stanley