Fig. 5.1.13 Stress fracture of the left os naviculare pedis in a 24-year-old male elite runner. This is one of the few stress fractures that may demand total immobilization because of the risk of later necrosis.

Fig. 5.1.14 Stress fracture in the ribs in a 24-year-old elite rower, following change of equipment to a new sweep-oar [33].

Other enthesopathies

The term 'enthesopathy' refers to calcification and bone formation due to aseptic inflammation at the site of tendon and ligament attachment. Scintigraphic changes appear earlier and are more sensitive than X-rays. Focal abnormal uptake is seen in the lateral epicondyle in cases of lateral epicondylitis ('tennis elbow'), and around the medial tuberosity of the calcaneus in the case of plantar fasciitis. Also, in Achilles tendinitis an increased uptake at the upper insertion of calcaneus as well as in the tendon may be found (Fig. 5.1.20). In athletes with groin pain, increased activity in the symphysis pubis, often with focal 'hot spots', is connected with inflammation of the symphysis, osteitis pubis(Fig. 5.1.21) [38].

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