Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Stress fractures of the tibia and fibula

Karl B Fields, MD
Section Editors
Patrice Eiff, MD
Richard G Bachur, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


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 [1].

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".)


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]


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Apr 2015. | This topic last updated: Feb 4, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Beck BR. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 1998; 26:265.
  2. Lundon, K, Melcher, L, Bray, K. Stress fractures in ballet: a twenty-five year review. J Dance Med Sci 1999; 3:101.
  3. Hulkko, A, Alen, M, Orava, S. Stress fractures of the lower leg. Scand J Sports Sci 1987; 9:1.
  4. Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987; 15:46.
  5. DiFiori JP. Stress fracture of the proximal fibula in a young soccer player: a case report and a review of the literature. Med Sci Sports Exerc 1999; 31:925.
  6. Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16:179.
  7. Friberg O. Leg length asymmetry in stress fractures. A clinical and radiological study. J Sports Med Phys Fitness 1982; 22:485.
  8. Sullivan D, Warren RF, Pavlov H, Kelman G. Stress fractures in 51 runners. Clin Orthop Relat Res 1984; :188.
  9. Boden BP, Osbahr DC, Jimenez C. Low-risk stress fractures. Am J Sports Med 2001; 29:100.
  10. Crossley K, Bennell KL, Wrigley T, Oakes BW. Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc 1999; 31:1088.
  11. Niva MH, Kiuru MJ, Haataja R, Pihlajamäki HK. Bone stress injuries causing exercise-induced knee pain. Am J Sports Med 2006; 34:78.
  12. O'Connor FG, Wilder R, Nirschl R. Textbook of Running Injuries, McGraw Hill, New York 2001.
  13. Gaeta M, Minutoli F, Scribano E, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 2005; 235:553.
  14. Clare, DJ. Stress fractures of the ankle in the athlete. Oper Tech Sports Med 2001; 9:32.
  15. Rome K, Handoll HH, Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev 2005; :CD000450.
  16. Dickson TB Jr, Kichline PD. Functional management of stress fractures in female athletes using a pneumatic leg brace. Am J Sports Med 1987; 15:86.
  17. Coady CM, Micheli LJ. Stress fractures in the pediatric athlete. Clin Sports Med 1997; 16:225.
  18. Walker RN, Green NE, Spindler KP. Stress fractures in skeletally immature patients. J Pediatr Orthop 1996; 16:578.
  19. de la Cuadra P, Albiñana J. Pediatric stress fractures. Int Orthop 2000; 24:47.
  20. Yngve DA. Stress fractures in the pediatric athlete. In: The Pediatric Athlete, Sullivan JA, Grana WA. (Eds), American Academy of Orthopedic Surgery, Park Ridge 1988.