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Stress Fractures in Female Runners

Patient History

She reports running 70 miles a week for the last 5 months as directed by her coach and further states she ran 35 miles a week in high school. She reports apprehension about racing against such a high level of competition, feeling pressure from her coach to run fast, and feeling depressed after moving almost 10 hours away from home. She reports trying to eat as little as possible, because she feels her thighs and butt are too fat.

Objective assessment reveals the patient is 5' 9" weighing 107 lbs. with sharp pinpoint pain in her ® proximal and medial tibia. Patient flinches when direct pressure is applied to her shin and indicates it is the same pain she experiences when she is running. She states she experiences sharp intermittent pain in her lower leg at night when she is just watching TV and when she is in bed at night.

Shoe assessment reveals the patient's shoes are broken down with worn tread and notably increased wear on the lateral aspects. She reports she has been running in the same shoes for the past 9 months. Gait analysis reveals (B) hyperpronation, and decreased step length on the ®.

Patient should be referred to:

1. Physician: perform a complete check up.
2. Radiologist: perform X ray and bone scan or MRI.
3. Gynecologist: regulate menstrual flow.
4. Coach: discuss training regimen.
5. Athletic trainer: incorporate modalities and maintain daily check up on athlete's health.
6. Psychologist: depression, high levels of stress and anxiety issues relating to moving from home and competing, training and racing at a high level.
7. Dietian / nutritionist: appropriate meal planning, diet regulation, and caloric intake.
8. Orthotist: orthotics for hyperpronation
9. Family / friends: inform them and properly equip them to provide support for the patient.