Stress fractures of the foot and ankle

Abstract

Stress fractures were first described over 250 years ago and are believed to be the result of repetitive, prolonged muscular action on bone that has yet to accommodate or remodel. There is a close association with several well-known groups: military recruits, runners, and ballet dancers. Despite the easily identifiable populations, stress fractures are difficult to diagnose due to late appearance on standard radiograph. Therefore, a thorough history, a detailed physical exam, and a high level of suspicion are required to diagnose in a timely manner. Foot and ankle stress fractures make up a large percentage of the overall incidence of stress fractures with the tibia, fibula, metatarsals (MT), and calcaneus being more common and the navicular and sesamoid bones being less common. Although each bone has a slightly different etiology, presentation, and radiographic tendency, stress fractures of the foot and ankle are generally treated with activity modification and protected weight bearing, a difficult concept for the highly-active patient that usually presents. Prevention of stress fractures focuses on optimizing bone quality, sound training technique, and quality training equipment.