http://cdn.intechopen.com/pdfs/28466/InTech-Tibial_stress_injuries_aetiology_classification_biomechanics_and_the_failure_of_bone.pdf
Plateau:
Medial more common than lateral
Clinical features:
Well localised pain and tenderness over anterior medial aspect of upper tibia; may have oedema;
Differential diagnosis – pes anserinus bursitis
Treatment:
(see below under tibial shaft stress fractures)
Shaft:
Most common stress fracture
Aetiology:
Foot type – could be cavus (poor shock absorber) or pronated (increased muscle fatigue).
Clinical features:
Gradual onset of pain – aggravated by exercise. May be painful at rest.
Local tenderness over bone (most common on posteromedial aspect of lower third of shaft).
On x-ray only 10% have evidence of stress fracture – may see evidence of new periosteal bone formation.
Bone scan will show increased uptake.
Stress fractures can also occur on the anterior cortex, usually about midshaft; healing is often prolonged as non-union is common
Treatment:
Rest (maybe crutches or brace) until pain reduces – no or alternative sports activity until no longer tender to palpation (can take 4-8 weeks) gradual return to sports activity
Correct predisposing factors.
Medial malleolus:
Clinical features:
Vague discomfort over medial ankle with activity; local tenderness over medial malleolus; some oedema;
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