TREATMENT This injury most often responds to conservative treatment including modification of training and strength exercises over three months, the usual healing time. Partial weight bearing is usually allowed.
REFERRALS Refer to orthopaedic surgeon for consideration of surgery if symptoms are severe or diagnosis is delayed. Refer to physiotherapist for planning of a three to six months' return programme back to sport.
EXERCISE PRESCRIPTION Cycling and swimming and other low-impact activities are good alternatives to keep up general fitness. EVALUATION OF TREATMENT OUTCOMES
Monitor clinical symptoms and signs. Strength and flexibility must be monitored objectively to be the same as the other leg at the end of rehabilitation or there is a high risk that the weaker muscle will re-rupture.
DIFFERENTIAL DIAGNOSES Achilles tendon rupture (different location); DVT (gradual onset but can be difficult to rule out if the patient has recently taken a long-haul flight or had surgery). PROGNOSIS Excellent but re-ruptures are common following a too-early return to sport and insufficient rehabilitation.
SYMPTOMS Gradual onset of localised exercise-induced pain on fibula. This injury is common in young athletes but less common than tibia stress fractures. It typically occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact. AETIOLOGY This stress fracture is caused by excessive jumping or running exercises where rotation-pivoting landings are involved. CLINICAL FINDINGS There is localised tenderness on palpation and swelling over the fracture site. Pain can be provoked by repetitive jumping on the forefoot on hard ground.
INVESTIGATIONS X-ray is normal until callus formation has started or fracture displaces. MRI will show sub-cortical oedema at the fracture site but can often not identify the line of the stress fracture. CT scans usually show the fracture line better.
TREATMENT This injury most often responds to conservative treatment including modification of training over three months when the fracture is healed. There is seldom an indication for immobilisation or surgery. An ankle brace, reducing the rotation of the ankle, will reduce the symptoms. REFERRALS Refer to physiotherapist for planning of a three months' return programme back to sport. Note the errors in training that could have caused the injury and do not repeat. EXERCISE PRESCRIPTION Cycling and swimming are good alternatives to keep up general fitness. EVALUATION OF TREATMENT OUTCOMES Normal clinical symptoms and signs. DIFFERENTIAL DIAGNOSES Bone tumour (X-ray will differentiate). PROGNOSIS Excellent.
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