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