Stress Fractures of the Tibia

Harris, Joshua D.; Varner, Kevin E.

doi:10.1007/978-3-319-09238-6_10

Cited by 5 publications

(2 citation statements)

References 40 publications

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“…In the lower extremity, depending on the study and the group of athletes, the tibia seems to be most frequently affected before the metatarsals. Risk factors for a stress fracture of the tibia are an earlier stress fracture, an increase in the intensity or the duration of the training, insufficient technique during training, insufficient equipment during training, the so-called [ 88 , 117 ] ‘female athlete triad’ [ 137 ], a deficit in the intake of calcium and 25(OH)D, as well as an insufficient intake of calories [ 138 ].…”

Section: Localization Of Stress Fracturesmentioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

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Section: Localization Of Stress Fracturesmentioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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“…Stress injuries to the tibia are the fifth (tibial stress syndrome) and ninth (tibial stress fractures) most common running injury; combined, they account for approximately 1 in 10 running injuries [ 4 ]. Management and rehabilitation of a tibial stress injury involves a period of rest from high impact exercise and/or full immobilisation, followed by a slow integration back into exercise and sport [ 5 , 6 ]. The average passive rest period is 8.3 weeks [ 5 ], with return to normal activities taking up to 17 weeks depending on severity [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Acute Effects of Gait Interventions on Tibial Loads During Running: A Systematic Review and Meta-analysis

2022

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Introduction Changing running technique or equipment can alter tibial loads. The efficacy of interventions to modify tibial loads during running is yet to be synthesised and evaluated. This article reviewed the effect of running technique and footwear interventions on tibial loading during running. Methods Electronic databases were searched using terms relevant to tibial load and running. Interventions were categorised according to their approach (i.e., footwear; barefoot running; speed; surface; overground versus treadmill; orthotics, insoles and taping; and technique); if necessary, further subgrouping was applied to these categories. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) for changes in tibial loading were calculated and meta-analyses performed where possible. Results Database searches yielded 1617 articles, with 36 meeting the inclusion criteria. Tibial loading increased with (1) barefoot running (SMD 1.16; 95% CI 0.50, 1.82); (2) minimalist shoe use by non-habitual users (SMD 0.89; 95% CI 0.40, 1.39); (3) motion control shoe use (SMD 0.46; 95% CI 0.07, 0.84); (4) increased stride length (SMD 0.86; 95% CI 0.18, 1.55); and (5) increased running speed (SMD 1.03; 95% CI 0.74, 1.32). Tibial loading decreased when (1) individuals ran on a treadmill versus overground (SMD − 0.83; 95% CI − 1.53, − 0.12); and (2) targeted biofeedback was used (SMD − 0.93; 95% CI − 1.46, − 0.41). Conclusions Running barefoot, in motion control shoes or in unfamiliar minimalist shoes, and with an increased stride length increases tibial loads and may increase the risk of a tibial stress injury during periods of high training load. Adopting interventions such as running on a treadmill versus overground, and using targeted biofeedback during periods of high loads could reduce tibial stress injury.

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