Periosteal Tears, Stress Fx

Microfractures in normam bone caused by overuse and repetitive actions. Can be caused by redistributing of impact force through a focal oint of bone, or by the pull of MM on a bone.

• High physical fitness
• Hard training surface, poor shoe choice
• Excessive pronation, mid/forefoot hypomobility or rigid cavus arch
• + amenorrheeic women

• NSAIDs =bad for bone healing
• Frictions/extreme hydro if inflamed
• Early return to full activity

• Local pain and tenderness over Fx site - Horizontal orientation
• Gradual onset of pain (often exercise not redused)
• Initially, pain during activity, reduced when stopped
• Pain increases during activity, more deep+constant, eventually at rest and at night
• Pain increased w/ weight bearing (downhill run, deccelaration)

• Nature and behavior of pain
• Changes in exercise, shoes, other physical stress activities
• Health, diet, menstruation

• Local swelling
• Erythema, foot biomechanics, lower leg, knee

• Tenderness (often severe) on deep pressure to bony surface a couple cm both above and below site
• No pain a few cm away
• Pain on superficial/moderate pressure on site of suspected Fx

No change, unless swelling or pain interferes

Usually not

Maybe as bone Fx, sclerotomic

• Snap test - snap DIST+PROX (or tuning fork)
• + (suspicion) = deep sclerotomic Pain

• pt edu (lay off it, shoes, biomechanics)
• Decr inflammation (shunt)
• Prevent adhesions (stretch)

• Elevate
• Shunt
• Stretch
• Comps

• Acute
• Ice to CBAN for inflammation
• Sub-Acute
• Contrasts
• Chronic
• DMH, parafin waxx

• Acute
• Cycle w/o pain
• Sub-Acute
• Cross training
• Chronic
• Stretching, Cross training