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The risks of triathlon oversight: tibia stress fracture

The risks of triathlon oversight: tibia stress fracture

The stress fracture of the tibia is a frequent lesion in triathletes that have an important load of training. It is presented with diffuse pain in the ankle, related to the effort, and that yields to rest, becoming continuous if the injury progresses without being diagnosed. It can be easily confused with other pathologies if a good medical history and physical examination are not performed. The tibia axis presents a form of "s", which constitutes the optimal form of this structure to support the axial loads that are imposed on it, especially in the distal part, where this type of fractures happen, more frequently, some 6 centimeters above the ankle.

Causes of tibia stress fracture

Fatigue stress fractures occur in a bone without alterations, as a result of excessive load (repetition trauma or excessive repetitive muscle activity), for which the bone structure is not prepared. There are a number of factors that predispose to suffering this injury:
  • Once in order.
  • Errors in the career technique.
  • Alterations of the biomechanics of the race.

How is it diagnosed?

The diagnosis of these fractures is based on the medical history and physical examination. Clinically the most important symptom is pain, which at the beginning is mild and diffuse after training in the fracture area, and that disappears with rest. If not diagnosed and treated early, it still persists with rest and incapacitates the triathlete for their training. Performing a differential diagnosis with synovitis, tendonitis, tendinosis, or nerve entrapments by ultrasound diagnosis is essential to choose the proper treatment, since the fracture has a very different protocol. To corroborate the diagnosis, the following image tests can be performed:
  • Simple radiography: where the first changes in the bone (sclerosis band, fracture line, periodic bone formation) appear from the third week of the beginning of the symptoms.
  • Bone ganmography TC99: which presents an increase in capture in the fracture line.
  • TAC: Very useful for differential diagnosis.
  • MRI: very sensitive and highly specific.


How to treat tibia stress fracture

The treatment is fundamentally conservative, without the immobilizations, but with a modification of the activity for 6-8 weeks. In its acute phase it is necessary to avoid the load in the leg that the fracture has. It is also recommended to use conventional physiotherapy (magnetotherapy, inflammation, cryotherapy, etc.), as well as pharmacological treatment. In chronic phase the treatment requires proprioception and potentiation. The return to training after overcoming a fracture due to tibia stress will be progressively, performing in the first place in the water, in discharge, and introducing the load and impact little by little, under supervision of the physical rehabilitator and with periodic revisions by the physiotherapist or podiatrist.
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