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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 non-athletes 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 separately. (See "Overview of stress fractures" and "Stress fractures of the metatarsal shaft".)


The tibia is the major weight-bearing bone of the lower leg (picture 1 and picture 2). The proximal tibial plateau forms the lower surface of the knee joint (figure 1 and picture 3). The tibial shaft bridges the distance to the distal tibia, which contributes the superior articular surface of the ankle joint at the tibiotalar articulation as well as the medial malleolus. Another key bony landmark is the tibial tuberosity, which sits several centimeters below the knee joint line and serves as the attachment site for the patellar tendon. Although the tibial shaft is the most common site for stress fractures, they may also occur at the tibial plateau and the medial malleolus [2].

A strong fibrous structure, the interosseous membrane or ligament (figure 2), connects the tibia and fibula along the length of the two bones. Proximally, this structure, reinforced by strong anterior and posterior ligaments, forms a synovial joint, the proximal tibiofibular articulation (picture 4). Distally the interosseous membrane and three ligaments, the anterior, posterior, and transverse tibiofibular ligaments (figure 3 and figure 4), stabilize the superior ankle joint. Another fibrous structure, the crural fascia, surrounds the bones and muscles of the lower leg. Thus, although it bears far less weight than the tibia, the fibula is closely bound to the tibia by membranous and ligamentous attachments and is therefore susceptible to strain from some of the same deforming forces that cause tibial stress fractures [1].

Fascial extensions and the interosseous membrane separate the muscles, nerves, and vessels of the lower leg into four distinct compartments (figure 5): The anterior, posterior, and deep posterior compartments border the tibia; the lateral compartment borders the fibula.

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Literature review current through: Dec 2017. | This topic last updated: Jan 11, 2018.
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