Risk Factors: Intrinsic vs. Extrinsic

Several intrinsic and extrinsic factors influence the development of stress fractures in the FAC. Intrinsic Factors include: hormonal imbalances, cardiovascular fitness, and bone quality as well as anatomical characteristics like high arches and limb-length discrepancies. Extrinsic factors include: the type, intensity, and frequency of training, inadequate footwear or training on hard surfaces may exacerbate loading forces on the bones.

How Do Women Differ?

Women are especially vulnerable to lower limb stress fractures due to anatomical and physiological differences, including lower muscle bulk and compensatory increases in Q-angle (the angle between the quadriceps muscle and the patellar tendon). Foot pronation also contributes to increased stress on bones. In female athletes, the “female athlete triad” (relative energy deficiency, reduced BMD, and menstrual dysfunction) further increases their risk.

Does Location Matter?

The location of stress fractures in the FAC dictates the risk and progression of the injury. Low-risk fractures, which have a favorable healing trajectory, are typically located on the compressive side of the bone. These fractures are less likely to recur or result in non-union. In contrast, high-risk fractures occur in bones that endure tensile forces, such as the talus, navicular, proximal fifth metatarsal, and sesamoids of the hallux. These locations are more prone to progression to non-union or complete fracture.

Other posts you may like: