Medial more common than lateral
Well localised pain and tenderness over anterior medial aspect of upper tibia; may have oedema;
Differential diagnosis – pes anserinus bursitis
(see below under tibial shaft stress fractures)
Most common stress fracture
Foot type – could be cavus (poor shock absorber) or pronated (increased muscle fatigue).
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
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.
Vague discomfort over medial ankle with activity; local tenderness over medial malleolus; some oedema;