The Pathophysiology of Stress Fractures

Experimental validation of finite element predicted bone strain in the human metatarsal

“…Other components, which make up a small proportion of the bone composition, include proteoglycans, matrix proteins, growth factors, and cytokines (16).…”

“…This is likely, in part, because of difficulties in controlling for and quantifying training surfaces and terrains (16,17). Several studies have found no effect of training surface on the risk of stress fractures (12,18,19), while others have shown a correlation (20)(21)(22).…”

“…Sprinters, hurdlers, and jumpers are reported to have a higher risk of stress fractures in the foot, as large forces are involved at the heel and metatarsal heads in these activities (16,17). On the other hand, middle and long distance runners are more likely to suffer from stress fractures of the pelvis or the long bones of the lower limb (16,17). Non-weight bearing bones could also be susceptible to stress fractures depending on the activity.…”

“…Woven bone is highly mineralized and contains randomly-oriented, fine-fibred collagen which is not aligned with stress patterns. It is rapidly formed during development and after a fracture (16,52), and has lower mechanical strength than lamellar bone (63). The woven bone formed during development is replaced by lamellar bone by 4 years of age (16).…”

“…The major components of bone are hydroxyapatite mineral, type I collagen fibrils, and water (52). (56,57) and provides tensile strength (16) and ductility (58). Water fills the gaps in the mineralized collagen matrix, and also within the collagen fibril (52).…”