Today on the Doc On The Run Podcast, we’re talking about different types of tibial stress fractures in runners.
I recently did a telemedicine call with someone who had a tibial stress fracture. And she was actually really worried because she had one kind of tibial stress fracture, and her doctor freaked her out a little bit. He said, “You really shouldn’t be running on this. It could be really bad.” But she wasn’t clear on exactly what that meant. So if you look up tibial stress fractures, you’ll find all kinds of different things. Like a lot of times people say it’s just an extension of shin splints, that it’s really just a bad case of medial tibial stress syndrome, and that’s not really the case.
Now a tibial stress fracture is where your tibia has been overloaded repeatedly, and it’s at risk of cracking. And there are lots of things that you should understand that are important to understand about tibial stress fractures. For example, we know if you’re a man, and you start training, and you get a tibial stress fracture, it’s probably going to be a one-time event. If you can just get it to calm down, and just get it to heal, then you can continue to run and not have to worry about it that much after. But unfortunately, if you’re a woman and you get a tibial stress fracture, there’s a high probability, in fact like almost 50% of the time, you can actually get a second tibial stress fracture in the same place. So if you’re a woman and you get a tibial stress fracture, it’s really important that you understand the difference between different types of tibial stress fractures.
The best kind of tibial stress fracture, if there is such a thing as best, is one that’s in the middle of your shin. That’s an anterior tibial stress fracture that’s in the middle of the leg. The reason that’s better is that it’s far less likely to actually break. Now, if you do break your leg, that is actually one of the very worst places to break it. If you have a skiing injury and you get one of these things that we call a boot top fracture, where you’re skiing down the mountain, you hit something under the snow, your ski suddenly stops and you don’t, well, your boot is locked into the ski, your lower leg is locked into the boot, and the top of your leg keeps moving and you snap your tibia in half, right in the middle of it. That is a very, very bad injury. It’s very difficult to get that spot to heal. But fortunately, when that’s the place where you have a tibial stress fracture, it’s really not that bad. It’s not that risky.
In contrast, when you have what we call a distal tibial stress fracture, where you have a fracture that’s at a diagonal, right at the ankle joint, right basically at that time lump on the inside of your ankle that we call the medial malleolus, when you have a fracture there, this is a very, very high risk thing. In fact, I was just lecturing on stress fractures and runners at a medical conference recently, and one of the slides I have in there is about which kind of stress fractures might wind up in the operating room. And one of those four is a distal tibial stress fracture, because it’s so unstable if you run on it, it can very easily break, and then you have a displaced ankle fracture and you have to have surgery to fix it. And you’re probably going to get post-traumatic arthritis.
In that one, in fact, it’s completely reasonable for your doctor to actually recommend to take it to the operating room and put a screw or two in there to stabilize it so that you can move it and maintain your fitness and actually get back to running a lot faster than if you just have a cast or you just use a fracture walking boot. So they’re completely different in terms of those two kinds of tibial stress fractures. One of them, although it can be annoying, if you decrease the pressure to it, you decrease the activity that’s loading that bone, it can heal typically pretty uneventfully and you can actually do a lot of stuff to maintain your fitness with very little risk.
When you have the distal tibial stress fracture, where it’s right at the corner of your ankle joint, anything you do to move your foot can make it worse. So when you dorsiflex your foot, meaning that if you’re looking at your foot and you pull your toes up toward your shin or up toward your nose, you’re basically pulling the foot upward, and the front of the talus bone that sits under the tibia is actually shaped like a wedge and it’s wider in the front and skinnier in the back. So when you pull your foot upward, and you have a distal tibial stress fracture, you’re actually pushing that piece apart and you could actually break it. And that’s why it’s so high risk. You just really can’t do a lot to maintain your fitness if you’re always worrying about moving that thing out of position.
If you have a tibial stress fracture, and you’re not really sure what kind it is, make sure you pin your doctor down, or speak to somebody who’s a running injury expert and get a second opinion. You can do telemedicine visits, you can go see them, but you’ve always got to make sure you understand what you can do to maintain your running fitness and not wither away and just get weaker and weaker while you’re waiting for that tibial stress fracture to heal. That is a crucial ingredient to getting back to running as quickly as possible.
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