Stress Fractures About the Tibia, Foot, and Ankle

Stress Fractures About the Tibia, Foot, and Ankle

From the Summit Medical Group, Morristown, NJ (Dr. Shindle), the Department of Radiology and Imaging (Dr. Endo), the Department of Orthopedic Surgery (Dr. Warren and Dr. Ellis), and the Orthopedic Trauma Service (Dr. Lane and Dr. Helfet), Hospital for Special Surgery, New York, NY, and the Northern California Institute for Bone Health (Dr. Schwartz), Orinda, CA.

Dr. Warren or an immediate family member has received royalties from Biomet and Smith & Nephew and has stock or stock options held in Cayenne, OrthoNet, and ReGen Biologics. Dr. Lane or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Eli Lilly, Harvest Technologies, Novartis, and Weber Chilcott; serves as a paid consultant to Amgen, CollPlant, Bone Therapeutics SA, BioMimetic, DFine, Graftys, and Zimmer; has received research or institutional support from Amgen; and serves as a board member, owner, officer, or committee member of the Orthopaedic Research Society, the Musculoskeletal Tumor Society, the American Academy of Orthopaedic Surgeons, the Association of Bone and Joint Surgeons, and the American Society for Bone and Mineral Research. Dr. Helfet or an immediate family member has stock or stock options held in OHK Medical Devices and FxDEVICES. Dr. Schwartz or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Amgen, Eli Lilly, and Novartis and has received research or institutional support from Amgen, Eli Lilly, and Merck. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shindle, Dr. Endo, and Dr. Ellis.

Abstract
In competitive athletes, stress fractures of the tibia, foot, and ankle are common and lead to considerable delay in return to play. Factors such as bone vascularity, training regimen, and equipment can increase the risk of stress fracture. Management is based on the fracture site. In some athletes, metabolic workup and medication are warranted. High-risk fractures, including those of the anterior tibial diaphysis, navicular, proximal fifth metatarsal, and medial malleolus, present management challenges and may require surgery, especially in high-level athletes who need to return to play quickly. Noninvasive treatment modalities such as pulsed ultrasound and extracorporeal shock wave therapy may have some benefit but require additional research.

© 2012 by the American Academy of Orthopaedic Surgeons

1.   Michael K. Shindle, MD,
2.   Yoshimi Endo, MD,
3.   Russell F. Warren, MD,
4.   Joseph M. Lane, MD,
5.   David L. Helfet, MD,
6.   Elliott N. Schwartz, MD and
7.   Scott J. Ellis, MD

 

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