Stress Fracture Of Posterior Tibia

Fig. 76 A posterior stress fracture of the tibia will only be seen on an X-ray after callus is formed (three to six weeks]. MRI or bone scintigram shows the fracture within days of onset!

SYMPTOMS Gradual onset of localised exercise-induced pain at the posterior medial aspect of the tibia. This injury is common in young or adolescent athletes. It typically occurs as a result of sudden changes in training habits, such as increase in intensity or amount of impact.

AETIOLOGY This is a non-tension-side stress fracture, caused by excessive jumping or running exercises. The location usually correlates to the origin of the flexor digitorum longus or the posterior tibial muscle which can vary substantially between the left and right leg. Symptoms can therefore vary as well. CLINICAL FINDINGS There is localised tenderness on palpation and swelling over posterior medial tibia 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. MRI will show sub-cortical oedema at the fracture site but can often not identify the line of stress fracture. CT scans usually show the fracture line better.

Fig. 77 This X-ray shows a rare case of a complete stress fracture through the tibia which has healed well

TREATMENT This injury always responds to conservative treatment including modification of training over three months when the fracture is healed. There is seldom a need for immobilisation or surgery. REFERRALS Refer to physiotherapist for planning of a three months' return programme. 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. Running on soft surfaces is usually acceptable.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. DIFFERENTIAL DIAGNOSES Posterior chronic compartment syndrome (similar condition but deeper and more resistant to pain); Shin splints (more diffuse pain along the tibia border). PROGNOSIS Excellent.

This table provides advice on forms of exercise that may or may not be recommended for athletes with different injuries. The advice must be related to the severity and stage of healing and take the individual's situation into account.

This activity is harmful or risky.

The activity can be done but with care and with specific advice.

This activity can safely be recommended.

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