Stress fractures of the tibia and fibula
- Karl B Fields, MD
Karl B Fields, MD
- Section Editor — Adult Orthopedics
- Section Editor — Primary Care Sports Medicine
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics
- Professor of Family Medicine
- Oregon Health Sciences University
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Associate Professor of Pediatrics
- Harvard Medical School
Stress fractures of the tibia and fibula occur in many athletes, especially runners, and also in nonathletes who suddenly increase their activity level or have an underlying illness predisposing them to stress fractures. Many factors appear to contribute to the development of these fractures including changes in athletic training, specific anatomic traits, decreased bone density, and disease states .
This topic review will discuss stress fractures of the tibia and fibula in adults. An overview of stress fractures and discussions of other specific fractures are found elsewhere. (See "Overview of stress fractures" and "Stress fractures of the metatarsal shaft".)
EPIDEMIOLOGY, RISK FACTORS, AND MECHANISM OF INJURY
Both tibial and fibular stress fractures occur most commonly among athletes who participate in activities that involve prolonged walking, running, or jumping. Although most common among runners, where the incidence may be as high as 15 percent, these injuries also occur among ballet dancers, soccer and basketball players, and military recruits [2-5]. (See "Overview of running injuries of the lower extremity" and "Overview of stress fractures".)
Research into the etiology of tibial and fibular stress fractures is limited; however, possible risk factors are of three types:
- Activity-related factors, including excessive training, poor footwear, and irregular terrain [1,6]
- Biomechanical factors, including inflexibility or weakness of the calf muscles , unequal leg-length , and flat (pes planus) or high-arched (pes cavus) feet [8,9]
- Metabolic factors, including demineralized bone due to hormonal or nutritional imbalances and specific disease states
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- EPIDEMIOLOGY, RISK FACTORS, AND MECHANISM OF INJURY
- RELEVANT ANATOMY
- CLINICAL PRESENTATION AND EXAMINATION
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- Tibial stress fractures
- Fibular stress fractures
- Risk factor identification
- RECOMMENDATIONS FOR RETURN TO WORK AND SPORTS
- UNIQUE PEDIATRIC CONSIDERATIONS
- SUMMARY AND RECOMMENDATIONS