Long Time Stress Fracture in Fibula

[Bulldawgs07]

Doc & Rangers:

I've been fighting a stress fracture in my right fibula for upwards of 8 months now. Initially I (stupidly in retrospect) ignored it as I did not want to miss my summer training and get put behind the 8-ball, but I've been on a no run/no ruck profile since mid August. I got an x-ray around Thanksgiving and the doctor said that it looked like it was nearly or completely healed, and I should be able to get back to running soon. Problem is, everytime i feel ready to run, I start out very easy (i.e. slow jog/fast walk for around a mile or much less) and then it just goes back to constant pain (which he says is not something I should push through, supposedly). Any suggestions on how to kick this thing once and for all? I really can't stand not being able to run anymore.

Also, don't know this is a factor, but apparantly the doctor said I have an abnormally shaped fibia, thick at the bottom then suddenly thinner. Could this have been caused by ignoring the stress fracture, thereby causing a more permanent problem, or is it likely not an issue?

Sorry for the short story, any help is appreciated.

(EDITED to correct name of bone)

[Sleepy Doc]

"Hey, doc!.. it hurts when I do this.." (Well.. quit fuckin' doing that!..)

Stress fractures, as I'm sure your MD told you, are overuse injuries caused by doing specific activity or levels of intensity you aren't used to The absolute key with stress fractures is trying to find out what is causing the pain and eliminating/modifying that activity. The up side is that it is an easy fix. The downside is that you may have to permanently modify your activity. Theat being said, your MD was right; you do not want to "push through" the pain. The gold standard for being fully healed is 10 days pain free-i.e.- at the end of the day if you had any pain, the 10 day clock starts again. With this, slow and steady definitely wins the race.

You said your doctor told you it was a mis-shapen bone? Is it the tibia or fibula ? They are two differnt bones, brah.. (it actually makes a difference, from what I understand. The location of the pain can necessitate further consult by orthopedics..) This very well may be the case. Based on my limited experience, improperly fitted boots/shoes are a major contributing factor. You want to ensure that they have proper arch support, and if not buy some.

Have you tried doing weight training as modified PT? This is an excellent way to strengthen bones/muscles/ligaments and will make your job as a soldier much eaier... but you already know this... I assume you have been able to get with some of the sports med trainers at Yale? There has to be someone at Payne-Whitney that can help you. (Yes, I am a townie..)
If you need it, I can get you in touch with some people.

The bottom line? Deal with the modified activity for now. The more you push it, the longer it will take to get back to 100%

[EvilCouch]

"Hey, doc!.. it hurts when I do this.." (Well.. quit fuckin' doing that!..)

Stress fractures, as I'm sure your MD told you, are overuse injuries caused by doing specific activity or levels of intensity you aren't used to The absolute key with stress fractures is trying to find out what is causing the pain and eliminating/modifying that activity. The up side is that it is an easy fix. The downside is that you may have to permanently modify your activity. Theat being said, your MD was right; you do not want to "push through" the pain. The gold standard for being fully healed is 10 days pain free-i.e.- at the end of the day if you had any pain, the 10 day clock starts again. With this, slow and steady definitely wins the race.

You said your doctor told you it was a mis-shapen bone? Is it the tibia or fibula ? They are two differnt bones, brah.. (it actually makes a difference, from what I understand. The location of the pain can necessitate further consult by orthopedics..) This very well may be the case. Based on my limited experience, improperly fitted boots/shoes are a major contributing factor. You want to ensure that they have proper arch support, and if not buy some.

Have you tried doing weight training as modified PT? This is an excellent way to strengthen bones/muscles/ligaments and will make your job as a soldier much eaier... but you already know this... I assume you have been able to get with some of the sports med trainers at Yale? There has to be someone at Payne-Whitney that can help you. (Yes, I am a townie..)
If you need it, I can get you in touch with some people.

The bottom line? Deal with the modified activity for now. The more you push it, the longer it will take to get back to 100%

Listen to Sleepy Doc! I ignored his advice many years ago and ended up all fucked up because of it.

[Rangerguru]

take a knee, face out, pull security, change your socks and powder your feet. Seriously, listen to the Doc!!! I've seen him in action, he knows what he's doing.

[Bulldawgs07]

Roger, points taken Rangers. I won't do anything stupid on this one (or anything stupid I haven't already done at least).

Ranger The Sleepy Doc, it's my fibula (the smaller one in case I'm still wrong) I must've just contracted the two by mistake. I'm going to head out and get some properly fitted running shoes as step one and wait till I haven't had pain for a while to try it out. I had been using gel heel inserts, but obviously that isn't enough. IF it's not better by the time I get back to school around the 17th, I may take you up on the offer of contacting a trainer or something. Meantime I'll ask a couple of my varsity sports friends about traininers and their availability to intramural level athletes.

Thanks all for the replys, much appreciated.

[Bulldawgs07]

Update and more questions:

I just went to see the doctor for a follow-up today, having still experienced pain in the affected area. Both he and I agreed that the stress fracture should be healed by now. He is under the impression that it might be something called "muscular compartment disorder," brought on as a complication of the stress fracture. He is sending me for a bone scan to make certain the stress fracture is 100% healed, to be followed by a compartment test to see if that is the problem and how bad it is.

Beyond just the update, I was wondering if anyone is familiar with this condition, treatment, and recovery, especially as it relates to being able to continue doing Infantry stuff. From what I read online it seems like a full recovery is normal, but that surgery is often required. Any input is much appreciated.

[Sleepy Doc]

Any Update Bulldawg?..

I googled the condition you listed and couln't really find anything about it. I assume its just a milder (ie:non-emergent) form of compartment syndrome, because the etiology and treatment would be the same. If you've had the second bone scan done, I would any results with a grain of salt. All of the info I have on stress fractures states that even after they heal completely, they can still scan abnormally. This is due to the way the bone repairs itself (which I'm sure your MD explained to you..) by first weakening in order to become stronger. (For those who don't know, It's like taking weak bricks out of a wall to replace them with stronger bricks..)
Again, from my sources the gold standard is 10 days without pain, then gradually ease back into a normal routine. You have to be smart about it and utilize a varied workout routine that dosen't give your legs as much of pounding as a road march. Swimming, btw, is excellent for this.. or any aerobic excercise that would give you a good muscular workout at the same time. (martial arts, that tae-bo bullshit, regular chick aerobics.. )
Don't forget that you want to get a good stretch on too. By far the best way I've seen to do this is Yoga. (ya'll haters that think you can hang?.. try it for 1 hour and see how smoked you get... )

Bottom line is this; If you must, get the surgery.. but only as a last resort. I would try every thing else possible first, because once you get cut on you can't go and take it back. Be smart about it and work out a program that is best for you with your health care providers. Don't be a puss and think you can do it without help. I highly suggest utilizing a physical therapist. Get referrals from people and shop around. This potentially could effect the rest of your military career, good or bad..

Like I said before, I'm local so if you need pointed in the right direction, lemme know via PM.

Now I gotta get off my soap-box and sit my fat ass down on the couch to watch "Law and Order".. Where the FUCK did I put my beer?..

[Bulldawgs07]

Ranger The Sleepy Doc, I had the bone scan, and it came up negative. I assume the bone actually healed a while ago, and for quite a few months the pain has been due to whatever else is wrong with the leg, which would explain the lack of abnormalities on the scan, which he did mention the possibility of.

I have the muscular compartment test scheduled for this Thursday back in NY, so hopefully I'll have a definitive answer then as to the nature/severity of what's wrong. Once that happens we'll see the best course of action, but according to the doctor, the only treatment for this other than surgery is RICE, which I've been doing to no end since the summer with no results.

As for workout, I've been using the elliptical machine a lot, gives me a running-like motion without using that muscle or having any jarring to the leg. The major problem is that if I do anything that involves raising my toes up towards my leg, within three or four reps I have massive amounts of pain, something that has happened the few times I've tried swimming.

Anyway, I'll keep you posted once I get the results of the test, hopefully it'll give me all the info I need on what's wrong.

[91W]

Ranger Sleepy Doc,

This is the condition that is probably what his doc is thinking.

http://www.aapsm.org/chroniccompartment.html

Very rare. I was diagnosed with it in 2002. It sucks and can cause allot of pain. I elected to not do the surgery due to the fact that I was getting out of the Military.

Bulldawgs07,

While Chronic Compartment Syndrome is not a medical emergency, Acute Compartment Syndrome is. Listen to your Doc's and go with the treatment they recommend. I will tell you that if this is what you have you will need to have the surgery or look for a different career. It does not get better over time but can develop into Acute Compartment Syndrome for which emergency surgery is the only treatment. In Acute Compartment Syndrome the blood supply is cut off distal and nerve damage occurs in the affected compartment. Without prompt surgery there is a chance to lose a foot. The window to restore circulation is only around 2-4 hours. The nerve damage is usually immediate and permanent. I am not trying to scare you but wanting you to realize the importance of treatment. I modified the type of PT I do now but that is not necessarily on option in the Military. I cannot run further than 1 mile about once a week without extreme pain. So I swim and use an elliptical machine.

Edit to add: If your doc is not a Sports Medicine specialist you might want to look into finding one.

[bulldogg]

I had a similar compartment syndrome but in the left ulnar nerve. I thought I'd be Billy Bad Ass and ignore it and push through the pain... then the pain turned to numbness and after 6 months the numbness turned into loss of fine motor skills in my hand. When I couldn't button my own shirt I was on my way to the doc. They did the surgery and I got fine motor control back and regained 90% of the feeling in the part of my hand innervated by the ulnar nerve.

Moral of the story listen to the other two docs and dont fuck around with this condition, hua.

[Bulldawgs07]

Thanks for the input bulldogg and 91W. That condition the link is to is exactly what the doctor thinks it is. Assuming the test results come out the way we expect on Thursday, it seems the best and probably only option is the surgery. I sure as hell am not going to let some stupid ass injury like this make me need to get medically discharged.

I appreciate the cautionary tales, I'll be certain to keep the possibility of nerve damage or transitioning to the "acute" version in mind when doing any exercises.

[91W]

Bulldawg

Any update? How did your test go? I remember how much mine sucked.

[Bulldawgs07]

Yeah, it didn't exactly "go." Let's just say I'm not too happy with doctors right now.

I drove in for the test from Connecticut, get there and they tell me that it's just a pre-test appointment, which is BS. So they don't charge me the co--pay, but decide that I need to change doctors prior to any test because my current one wasn't a surgeon. I see him, he wants an MRI. I get the MRI, it's negative, and now they're trying to schedule the original test again.

Hopefully this thing will be soon, I'm sick of this crap.

[Bulldawgs07]

I finally had the pressure test on my leg today. I had them do both legs just in case, since my left one has been a bit sore and I didn't want to go through this crap again in a month. The test came back with a 30 (pre-exercise) on my right leg, so the doctor scheduled me for a surgery (fasciotomy) to release the pressure this coming Thursday. Hopefully I'll have a quick recovery, he said it can be as little as four weeks, but as much as four months if there are any complications.

Thanks for all the help and advice so far, I'll post on the results as time goes on post-surgery.

[bulldogg]

Be sure to tell them you want to be awake and watch the surgery... Good luck and listen to them on the post-op instructions, don't push it till they tell you to push it.