A 22-year-old college student comes to the office due to a 1-week history of right lower leg pain. She has mild dull pain at rest that becomes sharp and "bothersome" with exercise. She is an avid runner and has been preparing for an upcoming marathon event for the past 2 months. Her shoe has recently been bothering her, especially on the lateral side of the right foot. The patient has no other medical problems or history of recent trauma. Physical examination shows point tenderness and localized swelling over the right lower tibial border. The diagnostic study performed on the right lower extremity reveals a nondisplaced, distal tibial stress fracture. Which of the following is the most appropriate next step in the management of this patient?

Question

A 22-year-old college student comes to the office due to a 1-week history of right lower leg pain.  She has mild dull pain at rest that becomes sharp and "bothersome" with exercise.  She is an avid runner and has been preparing for an upcoming marathon event for the past 2 months.  Her shoe has recently been bothering her, especially on the lateral side of the right foot.  The patient has no other medical problems or history of recent trauma.  Physical examination shows point tenderness and localized swelling over the right lower tibial border. The diagnostic study performed on the right lower extremity reveals a nondisplaced, distal tibial stress fracture.  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: Most stress fractures of the lower extremities can be managed with conservative treatment. This includes pneumatic splinting and reduced weightbearing with a graduated exercise program. Crutches are often advised in the first 1-2 weeks to minimize weightbearing. The rehabilitation regimen may be scheduled over 8-12 weeks, but exercise intensity should be reduced and the regimen prolonged if the patient has recurrent symptoms during treatment. (Choice A) Calcium and vitamin D supplementation in postmenopausal women reduces the rate of bone loss, and may decrease the risk of osteoporotic fracture. However, there is currently no evidence that calcium and vitamin D supplementation accelerates healing or reduces the risk of stress fractures in younger patients without osteoporosis. (Choice B) Surgical correction with open reduction and internal fixation is not required in the majority of stress fractures. Adequate rest with a gradual return to activity is usually sufficient in mild cases. (Choice D) Advising on the proper shoe size and fit is important in preventing future injuries to the lower extremities; however, this patient should first be advised to reduce weightbearing with a gradual return to full-intensity exercise. Educational objective: Tibial stress fractures can be managed in most cases with pneumatic splinting, reduced weightbearing, and a graduated exercise program. Most patients may resume full-intensity exercise within 12 weeks, but the program may need to be delayed if the patient develops recurrent pain. References: Stress fractures: diagnosis, treatment, and prevention. (http://www.ncbi.nlm.nih.gov/pubmed/21888126)

A 22-Year-Old College Student Comes to the Office Due to a 1-Week