Tibial Stress Fracture?

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Hi,
I've been treating a competitive runner/triathlete over the past few months as her post tib becomes inflamed roughly an hour and a half into her long runs. With rest, Active Release, and orthotics it is nearly under control...
However...today seeing her she had some tenderness and mild edema on the distal anterior tib. No discolouration, no pain with movement or resisted movement, some tenderness with palpation of the tibia but not overly sensitive. Says its a constant mild ache.
It doesn't seem to be tendon related. I'm not entirely sure what's going on. I am curious what amount of swelling would be seen with a tibial stress fracture as I haven't seen one.
Plan is to see how it does with rest and ice - if no change then sending for x-ray next week - is this too soon? I've read its better to wait 4 weeks as new bone growth will show up better then the fracture itself.
Opinions?

Would love to hear feedback!

 

Tib stress # tend to be much more painful than that. Also get c/o night pain (aching/toothache like).

Sounds a little more likely to be Tibial Fasciitis (or Medial Tibial Stress Syndrome = MTSS). Pain and oedema on Distal 3rd of tib, other symptoms fit.....

Look at the foot biomechanics and address any issues such as excessive pronation. Look at appropriatness of footwear for her running. I think it'd be worth her seeing a good sports physio to look at overall posture andrunning technique (might not be immediately relevant, but would probably be of benefit to her). I've also found (personally and with some patients) stretching the anterior lower leg muscle group before and after running to be of some benefit. Icing daily 2x15min can help reduce swelling and some symptoms.

X-Ray wouldn't be much use for a stress # as the # will often be too small to see... Bone scan would show if there is any metabolic activity of the bone, indicating #.

I'm sure admin will be along shortly to provide some links as I now have a patient knocking my door down.....

Regards,

S

 

G'Day,

A stress fracture probably wont have oedema, and if the injury has only just occured, it peobably wont show on X-ray. Long term it might though. A bone scan might point to an increase in bloodflow to the area which might be a stress fracture.

Is it possible that in correcting the pathomechanics of the post-tib dysfunction, you're inadvertedly forcing the peroneals (especially the bervis and tertius) into overuse? Or possibly the plantarflexory moment of post tib is increased, leading to excess strain on tib ant?

Just a thought....
Cheers!